Healthcare Provider Details

I. General information

NPI: 1942230636
Provider Name (Legal Business Name): MIDWESTERN ENDOCRINOLOGY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
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 Number0439
License Number StateSD

VIII. Authorized Official

Name: MARK J OPPENHEIMER
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 605-275-6525