Healthcare Provider Details

I. General information

NPI: 1801080072
Provider Name (Legal Business Name): ELIZABETH ANN GRACE-CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN GRACE

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 69TH ST STE 1500
SIOUX FALLS SD
57108-8171
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5700
  • Fax: 605-322-5704
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7152
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier1801080072
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerARAZ/AMERICAS PPO
# 2
Identifier7101980
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 3
Identifier255534
Identifier TypeOTHER
Identifier State
Identifier IssuerMIDLANDS CHOICE
# 4
Identifier7152
Identifier TypeOTHER
Identifier State
Identifier IssuerDAKOTACARE
# 5
Identifier4992328
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBLUE CROSS BLUE SHIELD
# 6
Identifier65691
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSANFORD HEALTH PLAN
# 7
Identifier35M46GR
Identifier TypeOTHER
Identifier State
Identifier IssuerCC SYSTEMS/BLUE PLUS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: