Healthcare Provider Details

I. General information

NPI: 1841215654
Provider Name (Legal Business Name): DIABETES AND ENDOCRINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S MINNESOTA AVE STE 102
SIOUX FALLS SD
57105-0656
US

IV. Provider business mailing address

1320 S MINNESOTA AVE STE 102
SIOUX FALLS SD
57105-0656
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-8387
  • Fax: 605-334-0710
Mailing address:
  • Phone: 605-334-8387
  • Fax: 605-334-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEE J BRANDT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-335-1952