Healthcare Provider Details

I. General information

NPI: 1205090297
Provider Name (Legal Business Name): PHINIT PHISITKUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N SIOUX POINT ROAD
DAKOTA DUNES SD
57049-5312
US

IV. Provider business mailing address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-2667
  • Fax: 605-217-2900
Mailing address:
  • Phone: 605-217-2667
  • Fax: 605-217-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36706
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD-36706
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number13145
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number31630
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: