Healthcare Provider Details

I. General information

NPI: 1861141939
Provider Name (Legal Business Name): THEOPHILUS BORKETEY BORTIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUMMIT ST
YANKTON SD
57078-3855
US

IV. Provider business mailing address

501 SUMMIT ST
YANKTON SD
57078-3855
US

V. Phone/Fax

Practice location:
  • Phone: 605-668-8000
  • Fax: 605-665-0170
Mailing address:
  • Phone: 605-668-8000
  • Fax: 605-665-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18263
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: