Healthcare Provider Details

I. General information

NPI: 1043576853
Provider Name (Legal Business Name): KATIE ELIZABETH LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S GRANGE AVE SUITE 307
SIOUX FALLS SD
57105-0407
US

IV. Provider business mailing address

77 N HARMON DR
MITCHELL SD
57301-6242
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-7800
  • Fax: 605-328-7899
Mailing address:
  • Phone: 605-670-9305
  • Fax: 605-996-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0040
License Number StateSD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: