Individual
MICHAEL THOMAS PRUCHNICKI
Active
Individual
MICHAEL THOMAS PRUCHNICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
26940
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0058420
—
IA
01
—
050035373
RAILROAD MEDICARE #
IA
01
—
26940
TRICARE PROVIDER #
IA
01
—
27660
BLUE SHIELD PROVIDER #
IA
01
—
4267
MIDLANDS PROVIDER #
IA
01
—
IA0122
JOHN DEERE PROVIDER #
IA
Enumeration date
01/05/2006
Last updated
03/31/2020
Update your record
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