Healthcare Provider Details

I. General information

NPI: 1811568629
Provider Name (Legal Business Name): CAN CUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S LAKE AVE STE 201
SIOUX FALLS SD
57104-1300
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-5350
  • Fax:
Mailing address:
  • Phone: 605-333-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15534
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: