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General NPI Number Information
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NPI Number | 1033595822
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Entity Type | Individual
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Provider Name | STEFAN PROKOP M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST DEPARTMENT OF PATHOLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4238
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Country | US
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Telephone | 215-662-4829
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100159
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City | GAINESVILLE
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State | FL
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Zip | 32610-0159
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Country | US
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Telephone | 352-294-5781
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZN0500X
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Taxonomy Name | Neuropathology Physician
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License Number | ME140117
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License Number State | FL
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