MEDICARE: DERRICK A. DOOLITTLE 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	207R00000X	Internal Medicine Physician	6495	NE
2	2085R0202X	Diagnostic Radiology Physician	106274	MN
3	2085R0202X	Diagnostic Radiology Physician	55600	MN
4	2085R0202X	Diagnostic Radiology Physician	11534	SD

General Provider Information

NPI Number	:	1932494390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRICK A. DOOLITTLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 W 18TH ST STE LL03
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-4654
Country	:	US
Telephone Number	:	605-328-1410
Fax Number	:

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

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	08/29/2023

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