Provider Demographics
NPI:1407591258
Name:DAKOTA VASCULAR PROF LLC
Entity Type:Organization
Organization Name:DAKOTA VASCULAR PROF LLC
Other - Org Name:DAKOTA VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, PHD
Authorized Official - Phone:605-306-6140
Mailing Address - Street 1:3801 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6565
Mailing Address - Country:US
Mailing Address - Phone:605-306-6100
Mailing Address - Fax:605-306-6500
Practice Address - Street 1:3801 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6565
Practice Address - Country:US
Practice Address - Phone:605-306-6100
Practice Address - Fax:605-306-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TBDOtherTBD