Basic Information
| Provider Information | |||||||||
| NPI: | 1982821898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVISH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | COALE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 E. 20TH ST. | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053221300 | ||||||||
| FaxNumber: | 6053221301 | ||||||||
| Practice Location | |||||||||
| Address1: | 6100 S LOUISE AVE STE 2100 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571086021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055041100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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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 | 207X00000X | P0036 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 5101016956 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 10219 | SD | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 302937302 | 05 | TX | MEDICAID |