MEDICARE: FAHIMA A QALBANI M.D.

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	2085R0202X	Diagnostic Radiology Physician	2590	SD
2	2085U0001X	Diagnostic Ultrasound Physician	2590	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629071881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAHIMA A QALBANI M.D.

Provider Business Mailing Address
First Line	:	612 N SIOUX POINT RD
Second Line	:	STE 500
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5084
Country	:	US
Telephone Number	:	605-232-6200
Fax Number	:	605-235-0004

Provider Business Practice Location Address
First Line	:	612 N SIOUX POINT RD
Second Line	:	STE 500
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5084
Country	:	US
Telephone Number	:	605-232-6200
Fax Number	:	605-235-0004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/16/2008

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