DR. MARK LAWRENCE PROCHASKA M.D. NPI 1417953290

NPI Information

NPI: 1417953290
Provider Name: DR. MARK LAWRENCE PROCHASKA, M.D.
Classification: Psychiatry & Neurology - 2084P0805X
Entity Type: Individual

Specialization: Geriatric Psychiatry

PECOS Registration: Yes

Address:
7011 W 121ST ST
STE 105
OVERLAND PARK, KS
ZIP 66209
Phone: (913) 345-1191
Get Directions

DR. Mark Lawrence Prochaska, M.D. is a geriatric psychiatry psychiatry neurology in Overland Park, KS. The provider is geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. DR. Mark Lawrence Prochaska, M.D. NPI is 1417953290. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

7011 W 121ST ST
STE 105
OVERLAND PARK, KS
ZIP 66209-029
Phone: (913) 345-1191
Fax: (913) 345-1464

The NPI 1417953290 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/25/2005 and was last updated on 7/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0805X	Psychiatry & Neurology	Geriatric Psychiatry	04-21187	KANSAS	Yes
2	2084P0802X	Psychiatry & Neurology	Addiction Psychiatry	04-21187	KANSAS	X
3	2084F0202X	Psychiatry & Neurology	Forensic Psychiatry	04-21187	KANSAS	X
4	2084P0800X	Psychiatry & Neurology	Psychiatry	04-21187	KANSAS	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0007208C	MEDICARE ID-TYPE UNSPECIFIED	KANSAS
2	C51594	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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