Healthcare Provider Details

I. General information

NPI: 1306841382
Provider Name (Legal Business Name): TIMOTHY T O'SHEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S EUCLID AVE STE 510
SIOUX FALLS SD
57105-0404
US

IV. Provider business mailing address

2912 S HOLLY AVE
SIOUX FALLS SD
57105-4412
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-7500
  • Fax: 605-328-7599
Mailing address:
  • Phone: 605-336-3230
  • Fax: 605-328-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3534
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: