# PRUCHNO MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225433675
- **Authorized official:** CHARLES J PRUCHNO M.D. (OWNER / PROVIDER)
- **Authorized official phone:** (319) 247-3899

## Contact information

- **Practice address:** 202 10TH ST SE, SUITE 200, CEDAR RAPIDS, IA 52403-2414
- **Practice address phone:** (319) 247-3899
- **Mailing address:** PO BOX 1112, CEDAR RAPIDS, IA 52406-1112
- **Mailing address phone:** (319) 247-3899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 27892 | IA | Yes |

## Other

- **Enumeration date:** 10/28/2014
- **Last updated:** 10/28/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1101865 | — | IA |