Healthcare Provider Details

I. General information

NPI: 1497139810
Provider Name (Legal Business Name): THEIN HTIKE WIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

3400 MINISTRY PKWY
WESTON WI
54476-5220
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-4973
  • Fax:
Mailing address:
  • Phone: 715-393-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number69470
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12213
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: