Organization
PRUCHNO MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J PRUCHNO M.D. (OWNER / PROVIDER)
(319) 247-3899
Entity
Organization
Contact information
Practice address
202 10TH ST SE, SUITE 200, CEDAR RAPIDS, IA 52403-2414
(319) 247-3899
Mailing address
PO BOX 1112, CEDAR RAPIDS, IA 52406-1112
(319) 247-3899
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27892
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1101865
—
IA
Enumeration date
10/28/2014
Last updated
10/28/2014
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