Provider Demographics
NPI:1689638249
Name:PROKUSKI, LAURA J (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:PROKUSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 N. CIVIC CENTER PLAZA
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6912
Mailing Address - Country:US
Mailing Address - Phone:480-874-2040
Mailing Address - Fax:480-874-2041
Practice Address - Street 1:3126 N CIVIC CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6912
Practice Address - Country:US
Practice Address - Phone:480-874-2040
Practice Address - Fax:480-874-2041
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34717207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ376601Medicaid
AZ376601Medicaid
AZZ125781Medicare PIN