Provider Demographics
NPI:1205018363
Name:TIANGCO, NOEL DEXTER LUIS (MD)
Entity Type:Individual
Prefix:
First Name:NOEL DEXTER
Middle Name:LUIS
Last Name:TIANGCO
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: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 1:1301 S CLIFF AVE
Practice Address - Street 2:STE 601
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-6930
Practice Address - Fax:605-322-6931
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443965207RP1001X
SD8277207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6007440Medicaid
SD6007442Medicaid
SD6007442Medicaid