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General NPI Number Information
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NPI Number | 1255338174
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Entity Type | Individual
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Provider Name | MARK GREGORY DESAUTEL MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 1310 W 22ND ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1501
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Country | US
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Telephone | 605-328-8200
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Fax | 605-328-8201
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Provider Business Mailing Address
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Address Line | PO BOX 5074
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5074
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Country | US
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Telephone | 605-328-6585
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Fax | 605-328-6512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 4246
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 4246
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 4246
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License Number State | SD
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Taxonomy #4
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number | 4246
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License Number State | SD
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Taxonomy #5
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | 4246
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License Number State | SD
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Taxonomy #6
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 4246
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License Number State | SD
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