Healthcare Provider Details

I. General information

NPI: 1225324791
Provider Name (Legal Business Name): TYLER ANTHONY PTACEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MINNESOTA ST STE 200
RAPID CITY SD
57701-7758
US

IV. Provider business mailing address

3509 DUNHAM DR
RAPID CITY SD
57702-0567
US

V. Phone/Fax

Practice location:
  • Phone: 605-342-3280
  • Fax:
Mailing address:
  • Phone: 402-340-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7731
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number12138
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2016019592
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6652
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: