Provider Demographics
NPI:1477681666
Name:PESCE, ULISES JORGE (PSYCHIATRIST)
Entity Type:Individual
Prefix:DR
First Name:ULISES
Middle Name:JORGE
Last Name:PESCE
Suffix:
Gender:M
Credentials:PSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:803 E DAKOTA
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-0148
Mailing Address - Country:US
Mailing Address - Phone:605-224-5811
Mailing Address - Fax:605-224-6921
Practice Address - Street 1:803 E DAKOTA
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-0148
Practice Address - Country:US
Practice Address - Phone:605-224-5811
Practice Address - Fax:605-224-6921
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0009355OtherBLUE CROSS BLUE SHIELD
SDP00163246OtherRAILROAD BENEFITS
SD0009355OtherBLUE CROSS BLUE SHIELD
SD9355Medicare ID - Type Unspecified