Provider Demographics
NPI:1497751341
Name:LOVRIEN, FRED CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:CLINTON
Last Name:LOVRIEN
Suffix:
Gender:M
Credentials:MD
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 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:605-328-2170
Mailing Address - Fax:605-328-2171
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 301
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-2170
Practice Address - Fax:605-328-2171
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2292207R00000X, 207RE0101X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6620048Medicaid
SDP00458473Medicare PIN
SDS1035Medicare PIN
D25438Medicare UPIN
SD6620048Medicaid
SDS100195Medicare PIN