Provider Demographics
NPI:1285689646
Name:DAKOTA ALLERGY & ASTHMA LTD
Entity Type:Organization
Organization Name:DAKOTA ALLERGY & ASTHMA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUBAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-336-6385
Mailing Address - Street 1:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:2200 W 49TH ST STE 104
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6550
Practice Address - Country:US
Practice Address - Phone:605-336-6385
Practice Address - Fax:605-336-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0348207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN73Q31DAOtherBCBS - GROUP
SD0007603OtherBCBS - GROUP
MN473395900Medicaid
MN73Q31DAOtherBCBS - GROUP
MN473395900Medicaid