Provider Demographics
NPI:1215285689
Name:PRABHU, YOGEESH HEROHALLY SHIVARAMAI (MBBS, MD)
Entity type:Individual
Prefix:DR
First Name:YOGEESH
Middle Name:HEROHALLY SHIVARAMAI
Last Name:PRABHU
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2217 ASCHINGER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2682
Mailing Address - Country:US
Mailing Address - Phone:917-657-3007
Mailing Address - Fax:
Practice Address - Street 1:5969 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1546
Practice Address - Country:US
Practice Address - Phone:718-613-4000
Practice Address - Fax:718-613-4101
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty