Provider Demographics
NPI:1467775957
Name:LOUIS J PROCHNICKI, M.D. , P.C.
Entity Type:Organization
Organization Name:LOUIS J PROCHNICKI, M.D. , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROCHNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-632-7707
Mailing Address - Street 1:1121 S GILBERT RD
Mailing Address - Street 2:102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5235
Mailing Address - Country:US
Mailing Address - Phone:480-632-7707
Mailing Address - Fax:480-926-1600
Practice Address - Street 1:1121 S GILBERT RD
Practice Address - Street 2:102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5235
Practice Address - Country:US
Practice Address - Phone:480-632-7707
Practice Address - Fax:480-926-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13402207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00133Medicare UPIN