Healthcare Provider Details

I. General information

NPI: 1881640233
Provider Name (Legal Business Name): LORNELL EUGENE HANSEN II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 S KELLEY AVE
SIOUX FALLS SD
57106-6300
US

IV. Provider business mailing address

3401 S KELLEY AVE
SIOUX FALLS SD
57106-6300
US

V. Phone/Fax

Practice location:
  • Phone: 605-274-0217
  • Fax: 605-275-6398
Mailing address:
  • Phone: 605-274-0217
  • Fax: 605-275-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30920
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number4768
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51491
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4768
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: