Basic Information
Provider Information | |||||||||
NPI: | 1942429394 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KLOPPER | ||||||||
FirstName: | HENDRIK | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 575 N SIOUX POINT RD | ||||||||
Address2: |   | ||||||||
City: | DAKOTA DUNES | ||||||||
State: | SD | ||||||||
PostalCode: | 570495312 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6052172667 | ||||||||
FaxNumber: | 6052172900 | ||||||||
Practice Location | |||||||||
Address1: | 575 N SIOUX POINT RD | ||||||||
Address2: |   | ||||||||
City: | DAKOTA DUNES | ||||||||
State: | SD | ||||||||
PostalCode: | 570495312 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6052172667 | ||||||||
FaxNumber: | 6052172900 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/24/2007 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
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 | 207T00000X | 30068 | NE | N |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   | 207T00000X | MD-43307 | IA | N |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   | 207T00000X | 8072 | SD | Y |   | Allopathic & Osteopathic Physicians | Neurological Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 6100760 | 05 | SD |   | MEDICAID |