Provider Demographics
NPI:1235796533
Name:UPPER MIDWEST MEDICAL INC
Entity Type:Organization
Organization Name:UPPER MIDWEST MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-828-4291
Mailing Address - Street 1:4201 S MINNESOTA AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6706
Mailing Address - Country:US
Mailing Address - Phone:605-335-3349
Mailing Address - Fax:
Practice Address - Street 1:4201 S MINNESOTA AVE STE 112
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6706
Practice Address - Country:US
Practice Address - Phone:605-335-3349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD208600000XOtherTAXONOMY