MEDICARE: DR. LUTHER MYRON HEGLAND JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	5455	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033173513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUTHER MYRON HEGLAND JR. MD

Provider Business Mailing Address
First Line	:	1821 PARKVIEW BLVD
Second Line	:
City	:	BRANDON
State	:	SD
Zip	:	57005-2624
Country	:	US
Telephone Number	:	605-553-6026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 S CLEVELAND AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-3245
Country	:	US
Telephone Number	:	605-368-1831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	03/26/2014

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