Basic Information
| Provider Information | |||||||||
| NPI: | 1851347561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIELIKE | ||||||||
| FirstName: | CAROL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6020 | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577096020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053423280 | ||||||||
| FaxNumber: | 6057218438 | ||||||||
| Practice Location | |||||||||
| Address1: | 717 SAINT FRANCIS ST | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577014677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053422880 | ||||||||
| FaxNumber: | 6053884621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 10/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2532 | SD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0008008 | 01 | SD | BCBS | OTHER | 5607673 | 05 | SD | MEDICAID | 080169997 | 01 | SD | RR MEDICARE | OTHER |