| NPI | 1750633004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK GREGORY DESAUTEL Owner 605-575-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology |
| 207YS0123X Otolaryngology, Facial Plastic Surgery | |
| 207YX0602X Otolaryngology, Otolaryngic Allergy | |
| 207YX0901X Otolaryngology, Otology & Neurotology | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery | |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2012-12-10 |