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Individual
RENU B PRAKASH
Active
Individual
RENU B PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
159456
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3190935
—
MA
01
—
S400105529
MEDICARE - GROUP #003473101
MA
01
—
S400105532
MEDICARE - GROUP #0034731
MA
Enumeration date
09/20/2005
Last updated
03/17/2025
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