Provider Demographics
NPI:1205046851
Name:BLEILE, MICHELLE J (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:BLEILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:J
Other - Last Name:TIGRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1301 S CLIFF AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1005
Mailing Address - Country:US
Mailing Address - Phone:605-322-7200
Mailing Address - Fax:605-322-7222
Practice Address - Street 1:1301 S CLIFF AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1005
Practice Address - Country:US
Practice Address - Phone:605-322-7200
Practice Address - Fax:605-322-7222
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7709207ZH0000X, 207ZP0102X
IA37656207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDCD5503OtherPALMETTO GPA RAILROAD
SDS104136OtherMEDICARE
SD0000034OtherBLUECROSS BLUESHIELD
SD5580120Medicaid
SD5580120Medicaid
SD5580120Medicaid