Healthcare Provider Details

I. General information

NPI: 1487624482
Provider Name (Legal Business Name): TERESA JO BORMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E SIOUX AVE
PIERRE SD
57501-3142
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-945-5560
  • Fax: 605-224-0369
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAK5061
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: