Provider Demographics
NPI:1386758134
Name:PRUCHNIEWSKI, JAMES F (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:PRUCHNIEWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4973 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3657
Mailing Address - Country:US
Mailing Address - Phone:863-859-4434
Mailing Address - Fax:863-859-5184
Practice Address - Street 1:4973 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3657
Practice Address - Country:US
Practice Address - Phone:863-859-4434
Practice Address - Fax:863-859-5184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1910213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041061600Medicaid
FL65027OtherBCBS
FL041061600Medicaid