Healthcare Provider Details

I. General information

NPI: 1417593153
Provider Name (Legal Business Name): MATTHEW ALEX FALK AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/26/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E SIOUX AVE STE 102
PIERRE SD
57501-3395
US

IV. Provider business mailing address

740 E SIOUX AVE STE 102
PIERRE SD
57501-3395
US

V. Phone/Fax

Practice location:
  • Phone: 605-494-0373
  • Fax:
Mailing address:
  • Phone: 605-494-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1036-A
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1036-A
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: