Basic Information
Provider Information | |||||||||
NPI: | 1447203047 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OFSTEIN | ||||||||
FirstName: | LEWIS | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 5009 | ||||||||
Address2: |   | ||||||||
City: | SIOUX FALLS | ||||||||
State: | SD | ||||||||
PostalCode: | 571175009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6059775000 | ||||||||
FaxNumber: | 6059775377 | ||||||||
Practice Location | |||||||||
Address1: | 4520 W 69TH ST | ||||||||
Address2: |   | ||||||||
City: | SIOUX FALLS | ||||||||
State: | SD | ||||||||
PostalCode: | 571088148 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6059775000 | ||||||||
FaxNumber: | 6059775377 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/18/2006 | ||||||||
LastUpdateDate: | 02/24/2010 | ||||||||
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 | 208G00000X | 2506 | SD | Y |   | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |   |
ID Information
ID | Type | State | Issuer | Description | 18-00049 | 01 |   | MEDICA SELECTCARE | OTHER | 24692 | 01 |   | HEALTH PARTNERS | OTHER | 0017216 | 01 | IA | SD BCBS | OTHER | 2506 | 01 | SD | DAKOTACARE | OTHER | 496L1OF | 01 | MN | MN BLUE SHIELD | OTHER | 931451029041 | 01 |   | PREFERRED ONE | OTHER | 336508500 | 05 | MN |   | MEDICAID | 0931949 | 05 | IA |   | MEDICAID | 91058OF | 01 | MN | MN BCBS - PLAN 91057NO | OTHER | 165031 | 01 |   | UCARE | OTHER | 7300620 | 05 | SD |   | MEDICAID |