Healthcare Provider Details

I. General information

NPI: 1710982996
Provider Name (Legal Business Name): MICHAEL E. FARRITOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/19/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S LAKE AVE SUITE 201
SIOUX FALLS SD
57104
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-5350
  • Fax:
Mailing address:
  • Phone: 605-328-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2533
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2533
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: