Provider Demographics
NPI:1053495598
Name:STROM, RICHARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:STROM
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 1:501 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3855
Mailing Address - Country:US
Mailing Address - Phone:605-655-1165
Mailing Address - Fax:605-668-6168
Practice Address - Street 1:501 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3855
Practice Address - Country:US
Practice Address - Phone:605-655-1165
Practice Address - Fax:605-668-6168
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9803207ZP0102X
SD7611207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0039848Medicaid
SDS103681Medicare PIN
MT000082233Medicare PIN
H49906Medicare UPIN
MT220031360Medicare PIN