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Individual

SHIMOGA RAMAIAH PRAKASH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
701 E COUNTY LINE RD, SUITE 101, GREENWOOD, IN 46143-1072
(317) 885-2860
(317) 885-2869
Mailing address
701 E COUNTY LINE RD, SUITE 101, GREENWOOD, IN 46143-1072
(317) 885-2860
(317) 885-2869

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01072406A
IN
208M00000X
Hospitalist Physician
Primary
01072406A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201163250
IN
Enumeration date
02/16/2007
Last updated
01/13/2022
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