Healthcare Provider Details

I. General information

NPI: 1740462803
Provider Name (Legal Business Name): RAQUEL DE LEON ANEL-TIANGCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAQUEL MARGUERITE DE LEON ANEL M.D.

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 10/11/2018
Certification Date:
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

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7600
  • Fax: 605-322-7601
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD435941
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number8278
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: