Healthcare Provider Details

I. General information

NPI: 1962983981
Provider Name (Legal Business Name): ANDREW HOLMSTROM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E 23RD ST
SIOUX FALLS SD
57105-2135
US

IV. Provider business mailing address

810 E 23RD ST
SIOUX FALLS SD
57105-2135
US

V. Phone/Fax

Practice location:
  • Phone: 605-777-7801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number1158
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: