Basic Information
| Provider Information | |||||||||
| NPI: | 1649216920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRACYK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 PARAMOUNT DR | ||||||||
| Address2: | MAILBOX # 44 | ||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027675199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088218556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 575 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172667 | ||||||||
| FaxNumber: | 6052172900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 05/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 35686 | IA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 35850 | WI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 8903 | SD | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 27413 | NE | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1649216920 | 05 | WI | MEDICAID | 1649216920 | 05 | NE | MEDICAID | 1442681 | 05 | IA | MEDICAID | 1649216920 | 05 | SD | MEDICAID |