Provider Demographics
NPI:1417910373
Name:DUCHENEAUX, COLETTE A (MD)
Entity Type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:A
Last Name:DUCHENEAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COLETTE
Other - Middle Name:A
Other - Last Name:REULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1309 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-1146
Mailing Address - Country:US
Mailing Address - Phone:605-845-3692
Mailing Address - Fax:605-845-8252
Practice Address - Street 1:1309 10TH AVE W
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-1146
Practice Address - Country:US
Practice Address - Phone:605-845-3692
Practice Address - Fax:605-845-8252
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5075207Q00000X
ND9037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1417910373Medicaid
SD5549050Medicaid
SD8611820Medicaid
SD8611820Medicaid
SDH66284Medicare UPIN