Individual
MICHAEL E PORVAZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3211 W REDDY WAY, BLOOMINGTON, IN 47403-4066
(812) 825-0777
Mailing address
3211 W REDDY WAY, BLOOMINGTON, IN 47403-4066
(812) 825-0777
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01060166A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200510710
—
IN
Enumeration date
06/17/2005
Last updated
03/27/2025
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