MEDICARE: DR. SURESH GOPALAKRISHNA PRABHU MD

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	9867	NV

General Provider Information

NPI Number	:	1730111436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESH GOPALAKRISHNA PRABHU MD

Provider Business Mailing Address
First Line	:	7100 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8383
Country	:	US
Telephone Number	:	702-545-0751
Fax Number	:	702-818-4817

Provider Business Practice Location Address
First Line	:	7100 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8383
Country	:	US
Telephone Number	:	702-545-0751
Fax Number	:	702-818-4817

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/04/2023

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