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General NPI Number Information
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NPI Number | 1366411878
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Entity Type | Individual
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Provider Name | JAY PROCHNAU MD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 1500 SALEM ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2164
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Country | US
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Telephone | 765-448-8000
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Fax | 765-448-8564
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Provider Business Mailing Address
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Address Line | 1200 W WHITE RIVER BLVD
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City | MUNCIE
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State | IN
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Zip | 47303-4988
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Country | US
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Telephone | 877-668-5621
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 01060643A
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License Number State | IN
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