Provider Demographics
NPI:1326097296
Name:PRUZINSKY, MARY SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:MARY SUSAN
Middle Name:
Last Name:PRUZINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SAINT FRANCIS DR
Mailing Address - Street 2:STE 411
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5619
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:319-272-5825
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:STE 411
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-5825
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30009207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA56464OtherBLUE CROSS BLUE SHIELD
IAF89689Medicare UPIN
IA56464OtherBLUE CROSS BLUE SHIELD
IA56464Medicare ID - Type Unspecified