Provider Demographics
NPI:1023081668
Name:AXTMAN, DAVID D (MS PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:AXTMAN
Suffix:
Gender:M
Credentials:MS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S GLENDALE AVE
Mailing Address - Street 2:PO BOX 5036
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1416
Mailing Address - Country:US
Mailing Address - Phone:605-274-2587
Mailing Address - Fax:
Practice Address - Street 1:1400 S GLENDALE AVE
Practice Address - Street 2:1305 W. 18TH ST.
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1416
Practice Address - Country:US
Practice Address - Phone:605-360-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0428363A00000X
IA100569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6821932Medicaid
SDS95386Medicare UPIN
SDS40520Medicare PIN
SD6821932Medicaid