Individual
MICHAEL THOMAS PRUCHNICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4200 UNIVERSITY AVE STE 300, WEST DES MOINES, IA 50266-5945
(515) 401-1950
(515) 401-1955
Mailing address
4200 UNIVERSITY AVE STE 300, WEST DES MOINES, IA 50266-5945
(515) 401-1950
(515) 401-1955
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
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