Provider Demographics
NPI:1093833840
Name:MICHAEL R. PUUMALA, M.D.,P.C.
Entity Type:Organization
Organization Name:MICHAEL R. PUUMALA, M.D.,P.C.
Other - Org Name:PUUMALA NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-322-8860
Mailing Address - Street 1:911 E 20TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1042
Mailing Address - Country:US
Mailing Address - Phone:605-322-8860
Mailing Address - Fax:
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1042
Practice Address - Country:US
Practice Address - Phone:605-322-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6100472Medicaid
SD6100472Medicaid
SD4686Medicare ID - Type Unspecified