Healthcare Provider Details

I. General information

NPI: 1417910373
Provider Name (Legal Business Name): COLETTE A DUCHENEAUX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLETTE A REULE MD

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 10TH AVE W
MOBRIDGE SD
57601-1146
US

IV. Provider business mailing address

1309 10TH AVE W
MOBRIDGE SD
57601-1146
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-3692
  • Fax: 605-845-8252
Mailing address:
  • Phone: 605-845-3692
  • Fax: 605-845-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5075
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9037
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: