Individual
DR. PRADEEP GNANAPRAGASAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
3920 ST FRANCIS WAY STE 220, LAFAYETTE, IN 47905-4922
(765) 428-5950
(765) 428-5951
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01075271A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201292900
—
IN
01
—
M47140142
MEDICARE
IN
Enumeration date
06/20/2011
Last updated
04/17/2023
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