Healthcare Provider Details

I. General information

NPI: 1396372405
Provider Name (Legal Business Name): GRANT MCLEOD VAN DER VOORT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 69TH ST
SIOUX FALLS SD
57108-2403
US

IV. Provider business mailing address

201 W 69TH ST
SIOUX FALLS SD
57108-2403
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-0635
  • Fax:
Mailing address:
  • Phone: 605-336-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number18044
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: