Individual
DR. SUMI PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1801 N SENATE BLVD, SUITE 230, INDIANAPOLIS, IN 46202-1252
(317) 962-5820
(317) 962-3916
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01070939A
IN
207R00000X
Internal Medicine Physician
2011026860
MO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01070939A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
2011026860
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201079490
—
IN
01
—
P02198454
MEDICARE RR
IN
Enumeration date
07/17/2007
Last updated
05/21/2019
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