Organization
TACTICAL IM PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS R LIDDELL MD (OWNER, MEDICAL DOCTOR)
(605) 595-2626
Entity
Organization
Contact information
Practice address
801 E SILVER POND PL, SIOUX FALLS, SD 57108-8392
(605) 595-2626
Mailing address
801 E SILVER POND PL, SIOUX FALLS, SD 57108-8392
(605) 595-2626
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8782
STATE LICENSE
SD
Enumeration date
02/27/2024
Last updated
02/27/2024
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