Individual
DEREK PRABHARASUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 838-4758
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01099585A
IN
208800000X
Urology Physician
60 255424
NY
208800000X
Urology Physician
74307
GA
208800000X
Urology Physician
ME122730
FL
Other
Enumeration date
02/13/2014
Last updated
05/08/2026
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