MEDICARE: EBRU SULANC M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	5363	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00261143	OTHER	SD	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	370624200	OTHER	SD	DEPT OF LABOR
2	273K1SU	OTHER	MN	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	273K1SU	OTHER	MN	CC SYSTEMS/ BLUE PLUS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	243215	OTHER	SD	MIDLANDS CHOICE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	309991041585	OTHER	SD	PREFERRED ONE
10	3300162	OTHER	SD	MEDICA
11	57105Y005	OTHER	SD	WPS TRICARE
12	HP43041	OTHER	SD	HEALTHPARTNERS
13	36784	OTHER	SD	SANFORD HEALTH PLAN
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	2111413	OTHER	SD	ARAZ/ AMERICA'S PPO
16	4995306	OTHER	SD	BLUE CROSS
17	5363	OTHER	SD	DAKOTACARE

General Provider Information

NPI Number	:	1093781874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBRU SULANC M.D.

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	911 E 20TH ST
Second Line	:	STE 500
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1042
Country	:	US
Telephone Number	:	605-322-7600
Fax Number	:	605-322-7601

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	12/26/2008

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