Prakash M Soares, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301057082 Issued in MI

Practice address

15200 Kercheval St
Grosse Pointe Park, MI 48230-1356

Phone

(313) 417-6100

Fax

(313) 417-6107

NPI assigned

Aug 15, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124020664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 77000",
            "address_2": "DEPARTMENT 771036",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482772000",
            "telephone_number": "586-447-4171",
            "fax_number": "586-447-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15200 KERCHEVAL ST",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301356",
            "telephone_number": "313-417-6100",
            "fax_number": "313-417-6107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOARES",
        "first_name": "PRAKASH",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301057082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2999173",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shauna Ryder Diggs MD PC
• Robina Ijaz Sial, M.D.
• Robert James Sisler, MSW
• Lindsay Marie Smith, MD MPH
• Anna Smolinski, LLMSW
• Surayya Soares, M.D.
• Speech With Sara LLC
• Monique Terese Spurlock
• Carly Steiner, M.ED, BCBA
• Jacqueline Ann Stoey

• Internal Medicine Physician in Grosse Pointe Park, MI
• Providers in Grosse Pointe Park, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.