Healthcare Provider Details

I. General information

NPI: 1720648066
Provider Name (Legal Business Name): DUSTIN P. COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

IV. Provider business mailing address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

V. Phone/Fax

Practice location:
  • Phone: 605-982-9545
  • Fax:
Mailing address:
  • Phone: 605-982-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67722
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number14182
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30237
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: