Provider Demographics
NPI:1013228402
Name:SOLE, JOSHUA S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:S
Last Name:SOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7350
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:2805 5TH ST
Practice Address - Street 2:100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7306
Practice Address - Country:US
Practice Address - Phone:605-755-5700
Practice Address - Fax:605-755-5701
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP 6392208100000X
390200000X
MN105686208100000X
MN54608208100000X
SD9491208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN250000960Medicare PIN