Provider Demographics
NPI:1063476422
Name:TKACH, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:TKACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:308 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2446
Mailing Address - Country:US
Mailing Address - Phone:775-388-1299
Mailing Address - Fax:
Practice Address - Street 1:2315 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4456
Practice Address - Country:US
Practice Address - Phone:775-753-6400
Practice Address - Fax:775-753-3551
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1063476422Medicaid
MEP00173725Medicare PIN
NV1063476422Medicaid