Provider Demographics
NPI:1801882287
Name:RENKA, RICHARD PIERCE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:PIERCE
Last Name:RENKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3628
Mailing Address - Country:US
Mailing Address - Phone:605-348-5401
Mailing Address - Fax:605-348-7319
Practice Address - Street 1:528 QUINCY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3628
Practice Address - Country:US
Practice Address - Phone:605-348-5401
Practice Address - Fax:605-348-7319
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD22252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7100070Medicaid
SD6777Medicare ID - Type Unspecified
SD7100070Medicaid