MEDICARE: PATRICK L RETTERATH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	2779	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4995672	OTHER	SD	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376588434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK L RETTERATH MD

Provider Business Mailing Address
First Line	:	1201 MICKELSON DR STE 2
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-7253
Country	:	US
Telephone Number	:	605-882-0432
Fax Number	:	605-882-0978

Provider Business Practice Location Address
First Line	:	1512 4TH ST NE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-6824
Country	:	US
Telephone Number	:	605-884-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	01/27/2010

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