Provider Demographics
NPI:1851365407
Name:PRASAD, JWALA (MD)
Entity type:Individual
Prefix:DR
First Name:JWALA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 CENTRAL PARK DR # 142
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1030
Mailing Address - Country:US
Mailing Address - Phone:517-515-5609
Mailing Address - Fax:517-515-5609
Practice Address - Street 1:2025 CENTRAL PARK DR # 142
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1030
Practice Address - Country:US
Practice Address - Phone:517-515-5609
Practice Address - Fax:517-515-5609
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036522207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101344294Medicaid
MI0330506OtherBCBS
MI101344294Medicaid
2330006Medicare ID - Type Unspecified