Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01053157A | IN |
N | 208600000X | Surgeon | 01053157A | IN |
Y | 2086S0129X | Vascular Surgeon | 01053157A | IN |
NPI | 1124027008 |
---|---|
Provider Name | Dr. Prasad V Gade |
First Address | Evansville, IN 47710-1682 |
Second Address | Evansville, IN 47710-1682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000174869 | ANTHEM BLUE CROSS/SHIELD (01) | IN |
01053157 | INDIANA STATE LICENSE (01) | IN |
200303060 | (05) | IN |
64013089 | (05) | KY |
BG4067422 | DEA (01) | IN |