Healthcare Provider Details

I. General information

NPI: 1821255647
Provider Name (Legal Business Name): PASTEL FLIGGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 4TH ST NW
WATERTOWN SD
57201-1558
US

IV. Provider business mailing address

901 4TH ST NW
WATERTOWN SD
57201-1558
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8471
  • Fax:
Mailing address:
  • Phone: 605-886-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8162
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53561
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: