Individual
DR. WIESLAW K. PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 PRESIDENTIAL BLVD, SUITE 100, BALA CYNWYD, PA 19004-1000
(610) 795-7366
(610) 664-4749
Mailing address
PO BOX 237, WYNNEWOOD, PA 19096-0237
(610) 795-7366
(610) 664-4749
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD419479
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19053230001
—
PA
Enumeration date
08/18/2005
Last updated
06/20/2012
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