Basic Information
| Provider Information | |||||||||
| NPI: | 1225324791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PTACEK | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6020 | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577096020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053423280 | ||||||||
| FaxNumber: | 6057910192 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E MINNESOTA ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053423280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 6652 | NE | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207Q00000X | 7731 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 208VP0014X | 2016019592 | MO | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0014X | 12138 | SD | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.