Healthcare Provider Details

I. General information

NPI: 1174594741
Provider Name (Legal Business Name): RAY T BIRKENKAMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N SANBORN BLVD
MITCHELL SD
57301-2449
US

IV. Provider business mailing address

305 N SANBORN BLVD
MITCHELL SD
57301-2449
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-2537
  • Fax: 605-996-0500
Mailing address:
  • Phone: 605-996-2537
  • Fax: 605-996-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberS2475
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6300290
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 2
Identifier25172
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSANFORD HEALTH PLAN
# 3
Identifier0009375
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK BCBS
# 4
Identifier2475
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDAKOTACARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: