Provider Demographics
NPI:1447280151
Name:PROK, CHRISTINE M
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:PROK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8691 FILIZ LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8025
Mailing Address - Country:US
Mailing Address - Phone:740-360-5728
Mailing Address - Fax:
Practice Address - Street 1:6520 WEST CAMPUS OVAL
Practice Address - Street 2:CENTRAL OHIO SURGICAL INSTITUTE
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054
Practice Address - Country:US
Practice Address - Phone:614-413-2233
Practice Address - Fax:614-413-2234
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN287773207L00000X
OHNA05478207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211421Medicaid
OH2211421Medicaid