Individual
SUDHAMANI PRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6780 MAYFIELD RD, MAYFIELD HTS, OH 44124-2203
(440) 449-4500
Mailing address
PO BOX 74647, CLEVELAND, OH 44194-0730
(440) 879-0081
(440) 879-0084
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
35-043763
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000347279
ANTHEM
OH
05
—
0615472
—
OH
Enumeration date
01/20/2006
Last updated
07/11/2007
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