Basic Information
| Provider Information | |||||||||
| NPI: | 1265408728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AWADALLAH | ||||||||
| FirstName: | SAMI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S. MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 S. CLIFF AVE | ||||||||
| Address2: | STE. 010 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053223666 | ||||||||
| FaxNumber: | 6053223665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 12/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 3446 | SD | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 46022474339 | 05 | NE | MEDICAID | 276575600 | 05 | MN | MEDICAID | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 7958 | 01 | SD | MIDLANDS CHOICE | OTHER | 1976670 | 05 | IA | MEDICAID | 6002362 | 05 | SD | MEDICAID | 722801028065 | 01 | SD | PREFERRED ONE | OTHER | 0008229 | 01 | SD | BLUE CROSS | OTHER | 034T5AW | 01 | MN | BLUE CROSS | OTHER | 034T5AW | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 13414 | 05 | ND | MEDICAID | 370019670 | 01 | SD | RR MEDICARE | OTHER | 24237 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 24981 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 3446 | 01 | SD | DAKOTACARE | OTHER | 2500708 | 01 | SD | MEDICA | OTHER | 57105I003 | 01 | SD | WPS TRICARE | OTHER | HP24496 | 01 | SD | HEALTHPARTNERS | OTHER |