Healthcare Provider Details

I. General information

NPI: 1184329435
Provider Name (Legal Business Name): DANIELLE THEIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE OLYMPIA COMBS

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 SHERIDAN LAKE RD
RAPID CITY SD
57702-9208
US

IV. Provider business mailing address

5410 SHERIDAN LAKE RD
RAPID CITY SD
57702-9208
US

V. Phone/Fax

Practice location:
  • Phone: 605-348-4141
  • Fax:
Mailing address:
  • Phone: 605-348-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18692
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: