Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 036148898 | IL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 19367 | WV |
NPI | 1023109444 |
---|---|
Provider Name | Dr. Ganga Prabhakar |
First Address | West Des Moines, IA 50266-8209 |
Second Address | Des Moines, IA 50314-3017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 16/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1804141000 | (05) | WV |
H20701 | (02) |