MEDICARE: DR. PRAVIN PRATAP M.D.

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	57.011812	OH
2	207R00000X	Internal Medicine Physician	01073197	IN
3	207RC0000X	Cardiovascular Disease Physician	01073197A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1101408456	OTHER	IN	ANTHEM BCBS

General Provider Information

NPI Number	:	1811105810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAVIN PRATAP M.D.

Provider Business Mailing Address
First Line	:	707 CEDAR ST STE 405
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-2059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 E DOUGLAS RD STE 208
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1465
Country	:	US
Telephone Number	:	574-335-6700
Fax Number	:	574-335-0726

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	03/27/2024

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Directions to “ DR. PRAVIN PRATAP M.D.” Practice Location

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