Individual
SURAJ PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.B.A
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 578-5855
(859) 341-4845
Mailing address
793 W STATE ST, COLUMBUS, OH 43222-1551
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01089063A
IN
2085R0202X
Diagnostic Radiology Physician
57559
KY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
57559
KY
Other
Enumeration date
03/30/2017
Last updated
08/22/2025
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