Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53101 | KY |
N | 208000000X | Pediatrician | TP642 | KY |
Y | 2080P0210X | Pediatric Nephrologist | 53101 | KY |
NPI | 1669735783 |
---|---|
Provider Name | Malavika Prasad |
First Address | Chicago, IL 60677-0909 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 03/09/2021 |