Healthcare Provider Details

I. General information

NPI: 1750302360
Provider Name (Legal Business Name): ROMEO AGANAD VIVIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOLDIER CREEK ROAD
ROSEBUD SD
57570-0400
US

IV. Provider business mailing address

PO BOX 400 SOLDIER CREEK ROAD
ROSEBUD SD
57570-0400
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-2231
  • Fax: 605-747-3628
Mailing address:
  • Phone: 605-747-2231
  • Fax: 605-747-3628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4861
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: