Individual
PRADEEP G. PRABHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 24565 HAIG ROAD, TAYLOR, MI 48180
(313) 375-2000
(313) 375-2165
Mailing address
HENRY FORD HEALTH SYSTEM, 24565 HAIG ROAD, TAYLOR, MI 48180
(313) 375-2000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301062997
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
324562410
—
MI
01
—
700H262280
BLUE CROSS-BLUE CROSS
—
01
—
PP062997
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
01/04/2007
Last updated
08/01/2012
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