Healthcare Provider Details

I. General information

NPI: 1922053628
Provider Name (Legal Business Name): PRESTON CC RENSHAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 S KELLEY AVE
SIOUX FALLS SD
57106-6300
US

IV. Provider business mailing address

3401 S KELLEY AVE
SIOUX FALLS SD
57106-6300
US

V. Phone/Fax

Practice location:
  • Phone: 888-782-8346
  • Fax: 605-275-6398
Mailing address:
  • Phone: 888-782-8346
  • Fax: 605-275-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7173
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24868
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: