MEDICARE: LYCIA C. THORNBURG, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1558224956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYCIA C. THORNBURG, M.D., P.C.

Provider Business Mailing Address
First Line	:	3535 5TH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6000
Country	:	US
Telephone Number	:	605-301-2661
Fax Number	:	605-301-2331

Provider Business Practice Location Address
First Line	:	3535 5TH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6000
Country	:	US
Telephone Number	:	605-215-6078
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LYCIA THORNBURG
Credential	:	MD
Telephone Number	:	605-301-2661

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	04/13/2026

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