| NPI | 1265113260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS PTACEK Physician 605-223-0011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-10-16 |