Healthcare Provider Details

I. General information

NPI: 1134165442
Provider Name (Legal Business Name): ROSSITZA T VAKARELSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W 69TH ST
SIOUX FALLS SD
57108-8148
US

IV. Provider business mailing address

1950 BLUEGRASS CIR STE 250 PO BOX 20190
CHEYENNE WY
82009-7365
US

V. Phone/Fax

Practice location:
  • Phone: 605-977-7000
  • Fax: 605-977-7001
Mailing address:
  • Phone: 307-635-5393
  • Fax: 307-635-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4569
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4569
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4569
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6004006
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 2
Identifier346793700
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 3
Identifier4994203
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBCBS
# 4
Identifier1564914
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 5
Identifier4569
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDAKOTA CARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: