Healthcare Provider Details

I. General information

NPI: 1669152773
Provider Name (Legal Business Name): SAHIL BAWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N PRAIRIE ST
FLANDREAU SD
57028-1243
US

IV. Provider business mailing address

212 N PRAIRIE ST
FLANDREAU SD
57028-1243
US

V. Phone/Fax

Practice location:
  • Phone: 605-997-5487
  • Fax: 605-997-2418
Mailing address:
  • Phone: 605-997-5487
  • Fax: 605-997-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18788
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: