Provider Demographics
NPI:1194164764
Name:PRASADH, INDU (MD)
Entity type:Individual
Prefix:
First Name:INDU
Middle Name:
Last Name:PRASADH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 AL HIGHWAY 75 N
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-3838
Mailing Address - Country:US
Mailing Address - Phone:256-891-0300
Mailing Address - Fax:256-891-7461
Practice Address - Street 1:460 AL HIGHWAY 75 N
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-3838
Practice Address - Country:US
Practice Address - Phone:256-891-0300
Practice Address - Fax:256-891-0300
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270782208000000X
MS23272208000000X
AL36702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL243633Medicaid
MS02358061Medicaid
AL244557Medicaid