Provider Demographics
NPI:1407858954
Name:NEDVED, LONNIE JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:JOSEPH
Last Name:NEDVED
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 1203
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7203
Mailing Address - Country:US
Mailing Address - Phone:605-996-1050
Mailing Address - Fax:605-996-1051
Practice Address - Street 1:1200 S BURR ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4584
Practice Address - Country:US
Practice Address - Phone:605-996-1050
Practice Address - Fax:605-996-1051
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3477207V00000X
WAMD00036138207V00000X
CAG48490207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD21514OtherSIOUX VALLEY HEALTH PLAN
SD6200650Medicaid
SD0001708OtherWELLMARK BCBS
SD3279OtherAVERA HEALTH PLAN
SD3477/GRP#8732644OtherDAKOTACARE
SDS1708Medicare ID - Type Unspecified
SD6200650Medicaid