Provider Demographics
NPI:1568427144
Name:DICK, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:DICK
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 1:605 N FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2902
Mailing Address - Country:US
Mailing Address - Phone:605-995-5756
Mailing Address - Fax:
Practice Address - Street 1:605 N FOSTER ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2902
Practice Address - Country:US
Practice Address - Phone:605-995-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE233882085R0001X
SD55112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00259242OtherRAILROAD MEDICARE
SD7208490Medicaid
NE47037660402Medicaid
SD7208490Medicaid
NEP00259242OtherRAILROAD MEDICARE
NE47037660402Medicaid
SDS1639Medicare PIN