Healthcare Provider Details

I. General information

NPI: 1609849165
Provider Name (Legal Business Name): DAKOTA HILLS FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BALLPARK RD SUITE 2
STURGIS SD
57785-2364
US

IV. Provider business mailing address

30321 ROOSEVELT CT
STURGIS SD
57785-6903
US

V. Phone/Fax

Practice location:
  • Phone: 605-720-1389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1247
License Number StateSD

VIII. Authorized Official

Name: DAVID LAUER
Title or Position: PHYSICIAN
Credential:
Phone: 605-720-1389