Healthcare Provider Details

I. General information

NPI: 1760760458
Provider Name (Legal Business Name): LUCY MARIA REIFEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DIALYSIS LANE
ROSEBUD SD
57570
US

IV. Provider business mailing address

PO BOX 719
ROSEBUD SD
57570-0719
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-5100
  • Fax:
Mailing address:
  • Phone: 605-747-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2508
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: