Provider Demographics
NPI:1629026422
Name:HIBBARD, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:HIBBARD
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 5009
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5009
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:NORTH CENTRAL HEART INSTITUTE
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3566207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0003875OtherSD BCBS
165026OtherUCARE
IA2997700Medicaid
SD6002593Medicaid
24678OtherHEALTH PARTNERS
MN7D930HIOtherMN BCBS - PLAN 91057NO
MN052307100Medicaid
MN538R9HIOtherMN BCBS - PLAN 538R2NO
SD3566OtherDAKOTACARE
IA53990OtherIA BCBS
931451029034OtherPREFERRED ONE
SDF31762Medicare UPIN
931451029034OtherPREFERRED ONE
IAI0605Medicare PIN
GA060028120Medicare PIN
MN060000745Medicare PIN