Healthcare Provider Details

I. General information

NPI: 1790758241
Provider Name (Legal Business Name): VINOD SAGAR BHATARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 04/18/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 S MINNESOTA AVE, STE 5
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

2116 S MINNESOTA AVE STE 5
SIOUX FALLS SD
57105-3750
US

V. Phone/Fax

Practice location:
  • Phone: 605-323-7976
  • Fax:
Mailing address:
  • Phone: 605-323-7976
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2449
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: