Provider Demographics
NPI:1417921685
Name:TYNAN, DANIEL GERARD (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GERARD
Last Name:TYNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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 610
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-8860
Practice Address - Fax:605-322-8868
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4653207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4653OtherDAKOTACARE
MN692007100Medicaid
SD57105AV02OtherWPS TRICARE
SDC70830623006OtherPREFERRED ONE
MN26G94TYOtherBLUE PLUS (DATES OF SERVICE PRIOR TO JOINING AVERA)
SD6100632Medicaid
MN6I363TYOtherCC SYSTEMS/ BLUE PLUS
HP14593OtherHEALTHPARTNERS
SD1417921685OtherARAZ/ AMERICA'S PPO
SD0006755OtherBLUE CROSS
SD0600326OtherMEDICA
231713OtherMIDLANDS CHOICE
231713OtherMIDLANDS CHOICE
MN6I363TYOtherCC SYSTEMS/ BLUE PLUS