Healthcare Provider Details

I. General information

NPI: 1497758718
Provider Name (Legal Business Name): PAUL W. WOLPERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL W. WOLPERT

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N SIOUX POINT RD STE 400
DAKOTA DUNES SD
57049-5088
US

IV. Provider business mailing address

612 N SIOUX POINT RD STE 400
DAKOTA DUNES SD
57049-5088
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-6353
  • Fax: 605-232-6500
Mailing address:
  • Phone: 605-232-6353
  • Fax: 605-232-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3864
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: