Individual
MARTIN WALTER PRUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3309 S 750 W, RUSSIAVILLE, IN 46979-9146
(765) 883-2273
(765) 883-5168
Mailing address
3309 S 750 W, RUSSIAVILLE, IN 46979-9146
(765) 883-2273
(765) 883-5168
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01073482A
IN
207Q00000X
Family Medicine Physician
12675
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000877337
ANTHEM
IN
05
—
201235770
—
IN
Enumeration date
05/17/2006
Last updated
09/27/2021
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