Provider Demographics
NPI:1841215654
Name:DIABETES AND ENDOCRINE CLINIC
Entity Type:Organization
Organization Name:DIABETES AND ENDOCRINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-335-1952
Mailing Address - Street 1:1320 S MINNESOTA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0656
Mailing Address - Country:US
Mailing Address - Phone:605-334-8387
Mailing Address - Fax:605-334-0710
Practice Address - Street 1:1320 S MINNESOTA AVE STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0656
Practice Address - Country:US
Practice Address - Phone:605-334-8387
Practice Address - Fax:605-334-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS1193OtherRAILROAD MEDICARE
MN97725DIOtherBCBS