Provider Demographics
NPI:1689785982
Name:NESBIT, MICHAEL TROY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TROY
Last Name:NESBIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 SAINT ANNE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4693
Mailing Address - Country:US
Mailing Address - Phone:605-343-1333
Mailing Address - Fax:605-343-6017
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:605-343-1333
Practice Address - Fax:605-343-6017
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLT0996207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00478929OtherRAILROAD MEDICARE
SDP00478929OtherRAILROAD MEDICARE
SD101411Medicare PIN