Provider Demographics
NPI:1033170543
Name:OPHEIM, KATHRYN D (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:OPHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 PIERCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1058
Mailing Address - Country:US
Mailing Address - Phone:712-226-2600
Mailing Address - Fax:712-226-2605
Practice Address - Street 1:345 W STEAMBOAT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5333
Practice Address - Country:US
Practice Address - Phone:605-217-2175
Practice Address - Fax:605-217-2185
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040461OtherWELLMARK BCBS
IA47804OtherWELLMARK BCBS
75305796357049A003OtherTRICARE
168OtherMIDLANDS CHOICE
NE75305796315Medicaid
SD9210414OtherDAKOTA CARE
SD20171OtherSIOUX VALLEY
IA2218222Medicaid
SD7776144Medicaid
SD20171OtherSIOUX VALLEY
SDA02493Medicare UPIN
75305796357049A003OtherTRICARE
SD7776144Medicaid