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NPI Code Detail

MEDICARE: DR. KEITH A. VOLLSTEDT M.D.

MEDICARE: DR. KEITH A. VOLLSTEDT 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
1208600000XSurgery Physician3656SD

General Provider Information

NPI Number : 1417951161
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH A. VOLLSTEDT M.D.
Provider Business Mailing Address
First Line : 705 N SIOUX POINT RD
Second Line : SUITE 100
City : DAKOTA DUNES
State : SD
Zip : 57049-5091
Country : US
Telephone Number : 605-217-5500
Fax Number : 605-217-5515
Provider Business Practice Location Address
First Line : 705 N SIOUX POINT RD
Second Line : SUITE 100
City : DAKOTA DUNES
State : SD
Zip : 57049-5091
Country : US
Telephone Number : 605-217-5500
Fax Number : 605-217-5515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 01/22/2010

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