Healthcare Provider Details

I. General information

NPI: 1588072532
Provider Name (Legal Business Name): MARIE ANGELICA LANDICHO DIAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number11482
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: