Healthcare Provider Details

I. General information

NPI: 1629071881
Provider Name (Legal Business Name): FAHIMA A QALBANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N SIOUX POINT RD STE 500
DAKOTA DUNES SD
57049-5084
US

IV. Provider business mailing address

612 N SIOUX POINT RD STE 500
DAKOTA DUNES SD
57049-5084
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-6200
  • Fax: 605-235-0004
Mailing address:
  • Phone: 605-232-6200
  • Fax: 605-235-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2590
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number2590
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: