Provider Demographics
NPI:1770966087
Name:LIGASAPUTRI, LIE DINAH SANDY (MD)
Entity type:Individual
Prefix:
First Name:LIE DINAH SANDY
Middle Name:
Last Name:LIGASAPUTRI
Suffix:
Gender:F
Credentials:MD
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 STE 400
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1046
Mailing Address - Country:US
Mailing Address - Phone:605-322-5780
Mailing Address - Fax:
Practice Address - Street 1:911 E 20TH ST STE 400
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1046
Practice Address - Country:US
Practice Address - Phone:605-322-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295572207R00000X
SD12003207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine