Provider Demographics
NPI:1285667949
Name:GROSKREUTZ, DAYNA JOY (MD)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:JOY
Last Name:GROSKREUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAYNA
Other - Middle Name:J
Other - Last Name:GROSKREUTZ BASEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1301 S CLIFF AVE
Practice Address - Street 2:STE 601
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-6930
Practice Address - Fax:605-322-6931
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35230207RC0200X, 207RP1001X, 207R00000X
SD8720207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20159OtherWELLMARK BCBS
IA0727545Medicaid
SD6008180Medicaid
IA0727545Medicaid
IAI17941Medicare PIN
SD6008180Medicaid