MEDICARE: PARK HIGHLAND MEDICAL CLINIC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1689855124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK HIGHLAND MEDICAL CLINIC, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 17962
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38187-0962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3836 PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-6633
Country	:	US
Telephone Number	:	901-324-3984
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SUDHA PRASAD
Credential	:	M.D.
Telephone Number	:	901-324-3984

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	02/19/2009

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