Individual
TIMOTHY HERBERT PRAHLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3500 FRANCISCAN WAY, MICHIGAN CITY, IN 46360-0021
(219) 879-8511
(219) 877-1081
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01044539A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036113678
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200185560
—
IN
01
—
351173213
SAGAMORE
IN
01
—
5229701
CCN
IN
01
—
5535745002
CIGNA
IN
01
—
82428
BCBS
IL
Enumeration date
08/25/2005
Last updated
01/23/2024
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