Healthcare Provider Details

I. General information

NPI: 1093781874
Provider Name (Legal Business Name): EBRU SULANC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E 20TH ST STE 500
SIOUX FALLS SD
57105-1042
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 TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number5363
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: