Individual
PRAKASH GIDDALURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
1666 E BERT KOUNS INDUSTRIAL LOOP STE 105, SHREVEPORT, LA 71105-5718
(318) 212-3520
(318) 212-3525
Mailing address
1666 E BERT KOUNS INDUSTRIAL LOOP STE 105, SHREVEPORT, LA 71105-5718
(318) 212-3520
(318) 212-3525
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
324787
LA
207Q00000X
Family Medicine Physician
N0788
TX
207Q00000X
Family Medicine Physician
PHY TEMP
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195141001
—
TX
01
—
8L0266
MEDICARE PTAN
TX
Enumeration date
11/15/2007
Last updated
11/08/2022
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