Provider Demographics
NPI:1033248869
Name:SRI, PRASIT (MD)
Entity type:Individual
Prefix:DR
First Name:PRASIT
Middle Name:
Last Name:SRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PRASIT
Other - Middle Name:
Other - Last Name:SRI-UTHAYOPAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9034 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2905
Mailing Address - Country:US
Mailing Address - Phone:219-836-0296
Mailing Address - Fax:219-836-0570
Practice Address - Street 1:9034 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-836-0296
Practice Address - Fax:219-836-0570
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025002A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
733657OtherFIRST HEALTH
35133426702OtherFISERV
4921815001OtherCIGNA
IN000000083225OtherANTHEM
4043990OtherAETNA
4043990OtherAETNA
IN000000083225OtherANTHEM
35133426702OtherFISERV