Healthcare Provider Details

I. General information

NPI: 1568415628
Provider Name (Legal Business Name): BIPINKUMAR AMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

IV. Provider business mailing address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-6800
  • Fax: 605-882-6831
Mailing address:
  • Phone: 605-882-6800
  • Fax: 605-882-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7849
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: