Healthcare Provider Details

I. General information

NPI: 1174103188
Provider Name (Legal Business Name): TODD A ESPICHA PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S 7TH AVE
SIOUX FALLS SD
57105-0998
US

IV. Provider business mailing address

1200 S 7TH AVE
SIOUX FALLS SD
57105-0998
US

V. Phone/Fax

Practice location:
  • Phone: 605-504-5400
  • Fax: 605-504-5150
Mailing address:
  • Phone: 605-504-5400
  • Fax: 605-504-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: