Provider Demographics
NPI:1245667575
Name:PRAFKA, MICHAEL RICHARDSON (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICHARDSON
Last Name:PRAFKA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6715 MCCRIMMON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-1916
Practice Address - Country:US
Practice Address - Phone:919-481-4997
Practice Address - Fax:919-388-3271
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245667575Medicaid
NCNCF711AMedicare PIN