Healthcare Provider Details

I. General information

NPI: 1689640187
Provider Name (Legal Business Name): MARK J OPPENHEIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3926 S WESTERN AVE
SIOUX FALLS SD
57105-6513
US

IV. Provider business mailing address

PO BOX 5126
SIOUX FALLS SD
57117-5126
US

V. Phone/Fax

Practice location:
  • Phone: 605-275-6525
  • Fax: 605-275-6970
Mailing address:
  • Phone: 605-335-1952
  • Fax: 605-373-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2757
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: