Provider Demographics
NPI:1841265543
Name:GUTNIK, LEONARD MARK (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:MARK
Last Name:GUTNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:6100 S LOUISE AVE STE 1120
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6021
Practice Address - Country:US
Practice Address - Phone:605-504-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE46022474335Medicaid
SD6000623Medicaid
MN30B75GUOtherCC SYSTEMS/ BLUE PLUS
SD0404413OtherMEDICA
ND12262Medicaid
SD23146OtherARAZ/ AMERICA'S PPO
SD370624200OtherDEPT OF LABOR
SD57105F002OtherWPS TRICARE
SD769201017553OtherPREFERRED ONE
MN914505200Medicaid
SD0005586OtherBLUE CROSS
SD110211778OtherRR MEDICARE
SD1526OtherMIDLANDS CHOICE
SD2478OtherDAKOTACARE
SD24850OtherSANFORD HEALTH PLAN
IA2920900Medicaid
MN92411422901OtherPRIMEWEST
SDHP32254OtherHEALTHPARTNERS
SD1526OtherMIDLANDS CHOICE
IA2920900Medicaid