Individual
CHANNA B PRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1648 HIGHWAY 95, BULLHEAD CITY, AZ 86442-7906
(928) 758-4114
(928) 758-4650
Mailing address
1648 HIGHWAY 95, BULLHEAD CITY, AZ 86442-7906
(928) 758-4114
(928) 758-4650
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
14827
AZ
207RC0000X
Cardiovascular Disease Physician
Primary
14827
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
249525
—
AZ
Enumeration date
04/26/2006
Last updated
02/22/2016
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