Healthcare Provider Details

I. General information

NPI: 1780099135
Provider Name (Legal Business Name): JAMES RONALD HEGVIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N SIOUX POINT RD STE 100
DAKOTA DUNES SD
57049-5091
US

IV. Provider business mailing address

705 N SIOUX POINT RD STE 100
DAKOTA DUNES SD
57049-5091
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-5500
  • Fax: 605-217-5515
Mailing address:
  • Phone: 605-217-5500
  • Fax: 605-217-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31594
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR-10078
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-45898
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: