Provider Demographics
NPI:1972566172
Name:BACHARACH, J MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:MICHAEL
Last Name:BACHARACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:MICHAEL
Other - Last Name:BACHARACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4520 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8148
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:
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:2006-04-10
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD39902086S0129X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6002910Medicaid
SD0004040OtherSD BCBS
IA56195OtherIA BCBS #
IA0970046Medicaid
931451029029OtherPREFERRED ONE
35693OtherHEALTH PARTNERS
SD3990OtherDAKOTACARE
165023OtherUCARE
MN03A41BAOtherMN BCBS - PLAN 91057NO
MN497L1BAOtherBCBS MN UNDER 538R2NO
MN575892100Medicaid
SDE40536Medicare UPIN
IA56195OtherIA BCBS #
MN575892100Medicaid
MN060000740Medicare PIN