Provider Demographics
NPI:1174556609
Name:TRAVNICEK, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:TRAVNICEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5045
Mailing Address - Street 2:P.F.S.
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-2000
Mailing Address - Fax:605-322-2030
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-2000
Practice Address - Fax:605-322-2036
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5884207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD349C2TROtherMN BLUECROSS BS
MN477608000Medicaid
SD4993479OtherBLUE CROSS OF SD
SD5884OtherDAKOTACARE
NE46022474331Medicaid
IA1174556609Medicaid
SD6631370Medicaid
SD349C2TROtherMN BLUECROSS BS
SDP00369249Medicare PIN