Healthcare Provider Details

I. General information

NPI: 1871112953
Provider Name (Legal Business Name): CORY ROBERT HEWITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 MOUNT RUSHMORE RD
RAPID CITY SD
57702-8754
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-646-9588
  • Fax:
Mailing address:
  • Phone: 605-646-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number18565
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number18565
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: