MEDICARE: JAN PRASAD 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	207RI0011X	Interventional Cardiology Physician	17912	AZ
2	207RC0000X	Cardiovascular Disease Physician	17912	AZ

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	AZ0408430	OTHER	AZ	BC/BS OF AZ

General Provider Information

NPI Number	:	1841276334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN PRASAD MD

Provider Business Mailing Address
First Line	:	PO BOX 98819
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8819
Country	:	US
Telephone Number	:	602-867-8644
Fax Number	:	602-795-5698

Provider Business Practice Location Address
First Line	:	3805 E BELL RD
Second Line	:	SUITE 3100
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2105
Country	:	US
Telephone Number	:	602-867-8644
Fax Number	:	602-795-5698

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	04/12/2022

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Directions to “ JAN PRASAD MD” Practice Location

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