Provider Demographics
NPI:1629071881
Name:QALBANI, FAHIMA A (MD)
Entity Type:Individual
Prefix:
First Name:FAHIMA
Middle Name:A
Last Name:QALBANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N SIOUX POINT RD
Mailing Address - Street 2:STE 500
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5084
Mailing Address - Country:US
Mailing Address - Phone:605-232-6200
Mailing Address - Fax:605-235-0004
Practice Address - Street 1:612 N SIOUX POINT RD
Practice Address - Street 2:STE 500
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5084
Practice Address - Country:US
Practice Address - Phone:605-232-6200
Practice Address - Fax:605-235-0004
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD25902085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE421337911-01Medicaid
IA0035261Medicaid
SD7202340Medicaid
NE421337911-00Medicaid
SD7202340Medicaid
NE421337911-01Medicaid
SDS3776Medicare PIN