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NPI Code Detail

MEDICARE: DR. JESSE LEE DIRKSEN M.D.

MEDICARE: DR. JESSE LEE DIRKSEN 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
1208600000XSurgery PhysicianMT189424PA
2208600000XSurgery Physician8404SD

General Provider Information

NPI Number : 1730389941
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE LEE DIRKSEN M.D.
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-6585
Fax Number : 605-328-6512
Provider Business Practice Location Address
First Line : 1508 W 22ND ST STE 101
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-1514
Country : US
Telephone Number : 605-328-3840
Fax Number : 605-328-3841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2007
Last Update Date : 02/26/2013

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