Individual
JAY PROCHNAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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