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General NPI Number Information
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NPI Number | 1790617264
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Entity Type | Individual
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Provider Name | PETER KOLB
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Gender | Male
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 1818 W FULTON ST STE 102
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City | RAPID CITY
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State | SD
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Zip | 57702-4347
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Country | US
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Telephone | 605-786-2448
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Fax |
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Provider Business Mailing Address
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Address Line | 23220 MORY RD
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City | RAPID CITY
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State | SD
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Zip | 57702-6005
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Country | US
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Telephone | 605-786-2448
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Fax |
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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 | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number | DL316605
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License Number State | SD
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