Basic Information
| Provider Information | |||||||||
| NPI: | 1104896083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOSADO | ||||||||
| FirstName: | JOSE MARIUS | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2400 S MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 S. CLIFF AVE. | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053224425 | ||||||||
| FaxNumber: | 6053224499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 5482 | SD | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4700115 | 01 | NE | UNITED HEALTHCARE | OTHER | 5482 | 01 | SD | DAKOTACARE | OTHER | 769221041935 | 01 | SD | PREFERRED ONE | OTHER | 0585679 | 05 | IA | MEDICAID | 4995171 | 01 | SD | BLUE CROSS | OTHER | 4700174 | 01 | SD | MEDICA | OTHER | 2182715 | 01 | SD | ARAZ/AMERICA'S PPO | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 46022474345 | 05 | NE | MEDICAID | 57105L015 | 01 | SD | WPS TRICARE | OTHER | HP45238 | 01 | SD | HEALTHPARTNERS | OTHER | 040130007 | 01 | MN | PRIMEWEST | OTHER | 244288 | 01 | SD | MIDLANDS CHOICE | OTHER | 36757 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 514T1DO | 01 | MN | CC SYSTEMS/BLUE PLUS | OTHER | 6701790 | 05 | SD | MEDICAID | 569197400 | 05 | MN | MEDICAID |