Healthcare Provider Details

I. General information

NPI: 1669478376
Provider Name (Legal Business Name): ROBERT A NELIMARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W 18TH ST
SIOUX FALLS SD
57104-4707
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8000
  • Fax: 605-328-8001
Mailing address:
  • Phone: 605-328-9556
  • Fax: 605-328-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1208
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number1208
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number1208
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: