Provider Demographics
NPI:1093781874
Name:SULANC, EBRU (MD)
Entity Type:Individual
Prefix:
First Name:EBRU
Middle Name:
Last Name:SULANC
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:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:STE 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1042
Practice Address - Country:US
Practice Address - Phone:605-322-7600
Practice Address - Fax:605-322-7601
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5363207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD370624200OtherDEPT OF LABOR
MN273K1SUOtherBLUE CROSS
SD6004890Medicaid
MN273K1SUOtherCC SYSTEMS/ BLUE PLUS
MN410012300Medicaid
SDP00261143OtherRR MEDICARE
SD243215OtherMIDLANDS CHOICE
NE46022474351Medicaid
SD309991041585OtherPREFERRED ONE
SD3300162OtherMEDICA
SD57105Y005OtherWPS TRICARE
SDHP43041OtherHEALTHPARTNERS
SD36784OtherSANFORD HEALTH PLAN
IA0582288Medicaid
SD2111413OtherARAZ/ AMERICA'S PPO
SD4995306OtherBLUE CROSS
SD5363OtherDAKOTACARE
SD36784OtherSANFORD HEALTH PLAN
SD6004890Medicaid