Individual
DR. MIRAMAR S PRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5401 44TH AVENUE DRIVE, SUITE 100, MOLINE, IL 51265-6401
(309) 779-5439
(309) 558-7026
Mailing address
5401 44TH AVENUE DRIVE, SUITE 100, MOLINE, IL 51265-6401
(309) 779-5439
(309) 558-7026
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036084335
IL
208000000X
Pediatrics Physician
Primary
036084335
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235105826
—
IL
05
—
2924712
—
IA
Enumeration date
02/24/2006
Last updated
01/15/2014
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