Provider Demographics
NPI:1649216920
Name:PRACYK, JOHN B (MD, PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:PRACYK
Suffix:
Gender:M
Credentials:MD, PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PARAMOUNT DR
Mailing Address - Street 2:MAILBOX # 44
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-5199
Mailing Address - Country:US
Mailing Address - Phone:508-821-8556
Mailing Address - Fax:
Practice Address - Street 1:575 N SIOUX POINT RD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5312
Practice Address - Country:US
Practice Address - Phone:605-217-2667
Practice Address - Fax:605-217-2900
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35686207T00000X
WI35850207T00000X
SD8903207T00000X
NE27413207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1649216920Medicaid
NE1649216920Medicaid
IA1442681Medicaid
SD1649216920Medicaid
WI710180646Medicare PIN
IAH77313Medicare UPIN
IA1442681Medicaid
NE1649216920Medicaid