MEDICARE: LEONARD MARK GUTNIK M.D.

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	207R00000X	Internal Medicine Physician	2478	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	110211778	OTHER	SD	RR MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	30B75GU	OTHER	MN	CC SYSTEMS/ BLUE PLUS
4	0404413	OTHER	SD	MEDICA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	23146	OTHER	SD	ARAZ/ AMERICA'S PPO
7	370624200	OTHER	SD	DEPT OF LABOR
8	57105F002	OTHER	SD	WPS TRICARE
9	769201017553	OTHER	SD	PREFERRED ONE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	0005586	OTHER	SD	BLUE CROSS
13	1526	OTHER	SD	MIDLANDS CHOICE
14	2478	OTHER	SD	DAKOTACARE
15	24850	OTHER	SD	SANFORD HEALTH PLAN
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	92411422901	OTHER	MN	PRIMEWEST
18	HP32254	OTHER	SD	HEALTHPARTNERS

General Provider Information

NPI Number	:	1841265543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD MARK GUTNIK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	6100 S LOUISE AVE STE 1120
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-6021
Country	:	US
Telephone Number	:	605-504-1700
Fax Number	:

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/31/2019

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