Provider Demographics
NPI:1023353885
Name:PRABHU, LLC
Entity type:Organization
Organization Name:PRABHU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLEEP MED/PULMON. CRIT. CARE
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVINKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-620-2248
Mailing Address - Street 1:43680 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4916
Mailing Address - Country:US
Mailing Address - Phone:734-620-2248
Mailing Address - Fax:
Practice Address - Street 1:43680 LAURELWOOD DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4916
Practice Address - Country:US
Practice Address - Phone:734-620-2248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization