Provider Demographics
NPI:1720034234
Name:CERVENKA, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:CERVENKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 MAIN ST E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1803
Mailing Address - Country:US
Mailing Address - Phone:952-758-1050
Mailing Address - Fax:952-758-5011
Practice Address - Street 1:301 MAIN ST E
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-1803
Practice Address - Country:US
Practice Address - Phone:952-758-1050
Practice Address - Fax:952-758-5011
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN19785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN943368600Medicaid
MND48457Medicare UPIN
MN089003598Medicare ID - Type Unspecified