MEDICARE: TIMOTHY HERBERT PRAHLOW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01044539A	IN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036113678	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	351173213	OTHER	IN	SAGAMORE
2	82428	OTHER	IL	BCBS
3	5229701	OTHER	IN	CCN
4	5535745002	OTHER	IN	CIGNA
5	351173213	OTHER	IN	HFN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	351173213	OTHER	IN	ISPAT INLAND

General Provider Information

NPI Number	:	1538152434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY HERBERT PRAHLOW MD

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	3500 FRANCISCAN WAY
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-0021
Country	:	US
Telephone Number	:	219-879-8511
Fax Number	:	219-877-1081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	01/23/2024

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Directions to “ TIMOTHY HERBERT PRAHLOW MD” Practice Location

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