MEDICARE: RICHARD E. ZIESKE PA

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	363A00000X	Physician Assistant	0492	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629072475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E. ZIESKE PA

Provider Business Mailing Address
First Line	:	PO BOX 5126
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5126
Country	:	US
Telephone Number	:	605-335-1952
Fax Number	:	605-373-9971

Provider Business Practice Location Address
First Line	:	1727 S CLEVELAND AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-3245
Country	:	US
Telephone Number	:	605-275-5560
Fax Number	:	605-275-5562

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/31/2012

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Directions to “ RICHARD E. ZIESKE PA” Practice Location

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