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NPI Code Detail

MEDICARE: DR. THOMAS MATTHEW BOETEL D.O.

MEDICARE: DR. THOMAS MATTHEW BOETEL D.O.
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
1208100000XPhysical Medicine & Rehabilitation PhysicianOS013636PA
2208100000XPhysical Medicine & Rehabilitation Physician7154SD
32081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician7154SD

General Provider Information

NPI Number : 1043276645
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS MATTHEW BOETEL D.O.
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-1848
Fax Number : 605-328-1898
Provider Business Practice Location Address
First Line : 1210 W 18TH ST
Second Line : SUITE 100
City : SIOUX FALLS
State : SD
Zip : 57104-9890
Country : US
Telephone Number : 605-312-8500
Fax Number : 605-312-8501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 04/04/2022

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