Provider Demographics
NPI:1609886308
Name:HUET-HOLM, LORRAINE M (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:HUET-HOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:M
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:5019 S WESTERN AVE
Practice Address - Street 2:STE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5095
Practice Address - Country:US
Practice Address - Phone:605-328-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3808207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6630520Medicaid
6352Medicare ID - Type Unspecified
SDS6352Medicare PIN
P53030Medicare UPIN