Individual
DR. MARK J PTACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
71 CHARLES ST, DEADWOOD, SD 57732-1303
(605) 717-6431
Mailing address
353 FAIRMONT BLVD, ATTN MSS, RAPID CITY, SD 57701-7375
(605) 755-8107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
16764
NE
207Q00000X
Family Medicine Physician
Primary
4872
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123937
MEDICA
NE
01
—
06676
NEBRASKA BCBS
NE
01
—
3859
MIDLANDS CHOICE
NE
01
—
460423930
HUMANA
NE
05
—
46042393011
—
NE
01
—
7988021
AETNA
NE
01
—
9214155
DAKOTA CARE
NE
Enumeration date
07/07/2005
Last updated
07/21/2022
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