Provider Demographics
NPI:1003889122
Name:DAKOTA HILLS FAMILY PRACTICE
Entity Type:Organization
Organization Name:DAKOTA HILLS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-720-1389
Mailing Address - Street 1:8329 N BLUCKSBERG MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-2812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 BALLPARK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2364
Practice Address - Country:US
Practice Address - Phone:605-720-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2411261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5602336Medicaid
SDD25428Medicare UPIN
SD41651Medicare ID - Type Unspecified