Provider Demographics
NPI:1992707434
Name:RAGHAVAN, PARULA PRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:PARULA
Middle Name:PRAKASH
Last Name:RAGHAVAN
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 1:1035 N EMPORIA
Mailing Address - Street 2:SUITE 245
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2972
Mailing Address - Country:US
Mailing Address - Phone:316-634-0482
Mailing Address - Fax:
Practice Address - Street 1:1035 N EMPORIA ST
Practice Address - Street 2:SUITE 245
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2944
Practice Address - Country:US
Practice Address - Phone:316-262-7662
Practice Address - Fax:316-262-8320
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100207080AMedicaid
KS021597Medicare ID - Type Unspecified
KS100207080AMedicaid