| NPI | 1033160676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONNE J MCKEE Credentialing Specialist 605-336-2638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 0012) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SD 0012) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2018-03-11 |