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NPI Code Detail

MEDICARE: DR. DAVID A ELLERBUSCH M.D.

MEDICARE: DR. DAVID A ELLERBUSCH 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
1207Q00000XFamily Medicine Physician1514SD

Other Identifiers

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

General Provider Information

NPI Number : 1972507713
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID A ELLERBUSCH M.D.
Provider Business Mailing Address
First Line : 600 N SYCAMORE AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57110-5745
Country : US
Telephone Number : 605-328-2999
Fax Number :
Provider Business Practice Location Address
First Line : 600 N SYCAMORE AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57110-5745
Country : US
Telephone Number : 605-328-2999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 05/08/2008

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