Healthcare Provider Details

I. General information

NPI: 1750332110
Provider Name (Legal Business Name): ROBERT K DAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E 20TH ST STE 501
SIOUX FALLS SD
57105-1047
US

IV. Provider business mailing address

PO BOX 5126
SIOUX FALLS SD
57117-5126
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-8282
  • Fax:
Mailing address:
  • Phone: 605-335-1952
  • Fax: 605-373-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1931
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier2913095
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier7301022
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 3
Identifier0041828
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBCBS
# 4
Identifier592787100
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 5
Identifier13228
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: