MEDICARE: JAMES PRUCHNIEWSKI DPM PA

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	332B00000X	Durable Medical Equipment & Medical Supplies	PO1910	FL

General Provider Information

NPI Number	:	1255509196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES PRUCHNIEWSKI DPM PA

Provider Business Mailing Address
First Line	:	4973 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3657
Country	:	US
Telephone Number	:	863-859-4434
Fax Number	:

Provider Business Practice Location Address
First Line	:	4973 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3657
Country	:	US
Telephone Number	:	863-859-4434
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES F PRUCHNIEWSKI
Credential	:	DPM
Telephone Number	:	863-859-4434

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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