Healthcare Provider Details

I. General information

NPI: 1669823670
Provider Name (Legal Business Name): HASSAN MEHMOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 S CLIFF AVE STE 3000
SIOUX FALLS SD
57105-1061
US

IV. Provider business mailing address

1315 S CLIFF AVE STE 3000
SIOUX FALLS SD
57105-1061
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7600
  • Fax: 605-322-7601
Mailing address:
  • Phone: 605-322-7600
  • Fax: 605-322-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT211637
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number12586
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: