Provider Demographics
NPI:1568457257
Name:PETEREIT, DANIEL GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GRANT
Last Name:PETEREIT
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 8010
Mailing Address - Street 2:353 FAIRMONT BLVD
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-8010
Mailing Address - Country:US
Mailing Address - Phone:605-719-8559
Mailing Address - Fax:605-719-2310
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-719-8559
Practice Address - Fax:605-719-2310
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD45422085R0001X
WI313682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
920005340OtherRAILROAD MEDICARE
SD6630570Medicaid
WY120275800Medicaid
F88316Medicare UPIN
SD6630570Medicaid