Provider Demographics
NPI:1982821898
Name:DEVISH, MICHAEL COALE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COALE
Last Name:DEVISH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E. 20TH ST.
Mailing Address - Street 2:STE. 300
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1045
Mailing Address - Country:US
Mailing Address - Phone:605-322-1300
Mailing Address - Fax:605-322-1301
Practice Address - Street 1:6100 S LOUISE AVE STE 2100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6021
Practice Address - Country:US
Practice Address - Phone:605-504-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0036207X00000X
MI5101016956207X00000X
SD10219207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302937302Medicaid
TX302937302Medicaid
TX402448ZH6HMedicare PIN