Healthcare Provider Details

I. General information

NPI: 1285667949
Provider Name (Legal Business Name): DAYNA JOY GROSKREUTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAYNA J GROSKREUTZ BASEL

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CLIFF AVE STE 601
SIOUX FALLS SD
57105-1032
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-6930
  • Fax: 605-322-6931
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35230
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35230
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35230
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number8720
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier20159
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BCBS
# 2
Identifier0727545
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 3
Identifier6008180
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: