Individual
DONNA PROHAZKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
117502
MO
2085B0100X
Body Imaging Physician
53021
WI
2085R0202X
Diagnostic Radiology Physician
117502
MO
2085R0202X
Diagnostic Radiology Physician
Primary
53021
WI
2085U0001X
Diagnostic Ultrasound Physician
117502
MO
2085U0001X
Diagnostic Ultrasound Physician
53021
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11377
ESSENCE
—
01
—
1853
BLUE CROSS BLUE SHIELD
—
05
—
203840202
—
MO
01
—
250846
HARMONY ID NUMBER
—
01
—
300092272
MEDICARE RAILROAD MO
—
01
—
434759
HEALTHLINK
—
01
—
5106488
AETNA
—
01
—
75030
HEALTH ALLIANCE
—
Enumeration date
07/20/2006
Last updated
03/10/2011
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