Basic Information
| Provider Information | |||||||||
| NPI: | 1962439182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PERSON | ||||||||
| OtherFirstName: | MIKE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 911 E 20TH ST | ||||||||
| Address2: | STE 700 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053340393 | ||||||||
| FaxNumber: | 6053346028 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 E. 20TH ST | ||||||||
| Address2: | STE 700 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053340393 | ||||||||
| FaxNumber: | 6053346028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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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 | 208600000X | MD-36886 | IA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 7546 | SD | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.