Healthcare Provider Details

I. General information

NPI: 1649946252
Provider Name (Legal Business Name): RAHUL BAJRACHARYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 PIERCE ST STE 100
SIOUX CITY IA
51105-1484
US

IV. Provider business mailing address

200 GOLD CIR STE 120
DAKOTA DUNES SD
57049-5501
US

V. Phone/Fax

Practice location:
  • Phone: 712-255-8901
  • Fax: 712-255-9161
Mailing address:
  • Phone: 605-217-0700
  • Fax: 605-217-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-53986
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: