Basic Information
| Provider Information | |||||||||
| NPI: | 1366462814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIOUXLAND UROLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052177000 | ||||||||
| FaxNumber: | 6052177015 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052177000 | ||||||||
| FaxNumber: | 6052177015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | HAAR | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6052177000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 3861 | SD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.