MEDICARE: DAVID D AXTMAN MS PA-C

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	0428	SD
2	363A00000X	Physician Assistant	100569	IA

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	:	1023081668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID D AXTMAN MS PA-C

Provider Business Mailing Address
First Line	:	1400 S GLENDALE AVE
Second Line	:	PO BOX 5036
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1416
Country	:	US
Telephone Number	:	605-274-2587
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 S GLENDALE AVE
Second Line	:	1305 W. 18TH ST.
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1416
Country	:	US
Telephone Number	:	605-360-5369
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	03/25/2022

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