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General NPI Number Information
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NPI Number | 1164611372
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Entity Type | Organization
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Legal Business Name | SIOUXLAND GASTROENTEROLOGY P C
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 101 TOWER ROAD SUITE105
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5072
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Country | US
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Telephone | 605-217-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 101 TOWER ROAD SUITE105
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5072
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Country | US
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Telephone | 605-217-4300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL PERSAUD
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Credential | DO
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Telephone | 605-217-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 3500
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License Number State | SD
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