Provider Demographics
NPI:1881699965
Name:PETRASKO, MARIAN S (MD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:S
Last Name:PETRASKO
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-312-2200
Practice Address - Fax:605-328-8429
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5437207RC0000X, 207RI0011X
IAMD-35730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6004810Medicaid
MN110011466Medicare PIN
SDP00471854Medicare PIN
SD6004810Medicaid
G38323Medicare UPIN
SDP00189588Medicare PIN
SDS42085Medicare PIN
MN110009886Medicare PIN