Individual
JAY PROCHNAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 SALEM ST, LAFAYETTE, IN 47904-2164
(765) 448-8000
(765) 448-8564
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
01060643A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000372081
ANTHEM PROVIDER NUMBER
IN
01
—
11438471
CAQH NUMBER
IN
05
—
200536580
—
IN
01
—
9333888
PHCS PID NUMBER
IN
Enumeration date
03/16/2006
Last updated
02/10/2021
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