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General NPI Number Information
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NPI Number | 1588156657
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Entity Type | Organization
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Legal Business Name | SAGE MEDICAL PROF LLC
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 345 W STEAMBOAT DR STE 701
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5287
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Country | US
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Telephone | 319-430-9340
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Fax |
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Provider Business Mailing Address
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Address Line | 345 W STEAMBOAT DR STE 701
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5287
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Country | US
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Telephone | 605-217-3345
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR, OWNER
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Name | CHAD ROGER LAURICH
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Credential | M.D.
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Telephone | 319-430-9340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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