Provider Demographics
NPI:1407852122
Name:WEINACHT, DONNA J (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:WEINACHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-7180
Mailing Address - Fax:605-328-7177
Practice Address - Street 1:6101 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5981
Practice Address - Country:US
Practice Address - Phone:605-312-8000
Practice Address - Fax:605-312-8001
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6701336Medicaid
SD370022488Medicare PIN
SDS40862Medicare PIN
SD6701336Medicaid
SD370022483Medicare PIN