Individual
DR. PRAVIN PRATAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 E DOUGLAS RD STE 208, MISHAWAKA, IN 46545-1465
(574) 335-6700
(574) 335-0726
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01073197
IN
207R00000X
Internal Medicine Physician
57.011812
OH
207RC0000X
Cardiovascular Disease Physician
Primary
01073197A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101408456
ANTHEM BCBS
IN
05
—
201193900
—
IN
Enumeration date
05/21/2007
Last updated
03/27/2024
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