Healthcare Provider Details

I. General information

NPI: 1740548692
Provider Name (Legal Business Name): SANFORD SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 22ND ST
SIOUX FALLS SD
57105-1554
US

IV. Provider business mailing address

1400 W 22ND ST
SIOUX FALLS SD
57105-1554
US

V. Phone/Fax

Practice location:
  • Phone: 605-357-1300
  • Fax:
Mailing address:
  • Phone: 605-357-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMARA VIK
Title or Position: PROGRAM DIRECTOR/CHILD PSYCHIATRY
Credential: MD
Phone: 605-322-5737