Basic Information
| Provider Information | |||||||||
| NPI: | 1689640187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OPPENHEIMER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5126 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053351952 | ||||||||
| FaxNumber: | 6053739971 | ||||||||
| Practice Location | |||||||||
| Address1: | 3926 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571056513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052756525 | ||||||||
| FaxNumber: | 6052756970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 02/21/2013 | ||||||||
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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 | 207RE0101X | 2757 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 495R1OP | 01 | MN | BCBS | OTHER | 052785800 | 05 | MN | MEDICAID | 4994889 | 01 | SD | SD BCBS | OTHER | P00194713 | 01 | RAILROAD MEDICARE | OTHER | 10025206600 | 05 | NE | MEDICAID | 2943845 | 05 | IA | MEDICAID | 6002053 | 05 | SD | MEDICAID |