Provider Demographics
NPI:1750356465
Name:KVALE, DANIEL J (PAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:KVALE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:BISON
Mailing Address - State:SD
Mailing Address - Zip Code:57620-0427
Mailing Address - Country:US
Mailing Address - Phone:605-244-5206
Mailing Address - Fax:605-244-5208
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BISON
Practice Address - State:SD
Practice Address - Zip Code:57620-0003
Practice Address - Country:US
Practice Address - Phone:605-244-5206
Practice Address - Fax:605-244-5208
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350300Medicaid
SD42507OtherMED B
SD42507OtherMED B
SD431827Medicare ID - Type UnspecifiedFQHC