Healthcare Provider Details

I. General information

NPI: 1043277593
Provider Name (Legal Business Name): CATHERINE A LEADABRAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 22ND AVE
BROOKINGS SD
57006
US

IV. Provider business mailing address

300 22ND AVE
BROOKINGS SD
57006-2480
US

V. Phone/Fax

Practice location:
  • Phone: 605-696-8021
  • Fax: 605-696-8830
Mailing address:
  • Phone: 605-696-8021
  • Fax: 605-696-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4544
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: