Healthcare Provider Details

I. General information

NPI: 1538386628
Provider Name (Legal Business Name): MICHAEL PRAMUKA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200C BUENA VISTA ST
PITTSBURGH PA
15212-4531
US

IV. Provider business mailing address

1200C BUENA VISTA ST
PITTSBURGH PA
15212-4531
US

V. Phone/Fax

Practice location:
  • Phone: 412-383-6879
  • Fax: 412-383-6597
Mailing address:
  • Phone: 412-383-6879
  • Fax: 412-383-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS009364L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: