Provider Demographics
NPI:1780764167
Name:MARTS, TERESA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:MARTS
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 1:825 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2688
Mailing Address - Country:US
Mailing Address - Phone:605-842-2626
Mailing Address - Fax:605-842-3557
Practice Address - Street 1:825 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2688
Practice Address - Country:US
Practice Address - Phone:605-842-2626
Practice Address - Fax:605-842-3557
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5601560Medicaid
SD5601563Medicaid
SD5601564Medicaid
0851370001OtherDME
SD5601560Medicaid
0851370001OtherDME
SD5601560Medicaid
SD7933Medicare PIN