Basic Information
| Provider Information | |||||||||
| NPI: | 1821021304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUUMALA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RICARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S. CLIFF AVE | ||||||||
| Address2: | STE 610 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053228860 | ||||||||
| FaxNumber: | 6053228868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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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 | 207T00000X | 4116 | SD | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 820816600 | 05 | MN | MEDICAID | 1821021304 | 05 | IA | MEDICAID | 6100473 | 05 | SD | MEDICAID | 10025568900 | 05 | NE | MEDICAID | 1821021304 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 41161 | 01 | SD | DAKOTACARE | OTHER | 46L91PU | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | HP43169 | 01 | SD | HEALTHPARTNERS | OTHER | 232615 | 01 | SD | MIDLANDS CHOICE | OTHER | 4992697 | 01 | SD | BLUE CROSS | OTHER | C83141030612 | 01 | PREFERRED ONE | OTHER | 57105AT03 | 01 | SD | WPS TRICARE | OTHER |