Provider Demographics
NPI:1356318570
Name:PROHASKA, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:PROHASKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 E SHANNON WOODS CIR # 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4100
Mailing Address - Country:US
Mailing Address - Phone:316-631-1600
Mailing Address - Fax:316-631-1698
Practice Address - Street 1:9828 E SHANNON WOODS CIR # 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4100
Practice Address - Country:US
Practice Address - Phone:316-631-1600
Practice Address - Fax:316-631-1666
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26939207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100395860BMedicaid
KS101528Medicare ID - Type Unspecified