Provider Demographics
NPI:1033435219
Name:PRAK, STEVEN T (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:PRAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14932
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-0019
Mailing Address - Country:US
Mailing Address - Phone:757-597-7699
Mailing Address - Fax:757-597-7099
Practice Address - Street 1:700 MOBJACK PL
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1957
Practice Address - Country:US
Practice Address - Phone:757-597-7699
Practice Address - Fax:757-597-7099
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006356213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist