Provider Demographics
NPI:1821021304
Name:PUUMALA, MICHAEL RICARD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICARD
Last Name:PUUMALA
Suffix:
Gender:M
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:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1301 S. CLIFF AVE
Practice Address - Street 2:STE 610
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-8860
Practice Address - Fax:605-322-8868
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4116207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN820816600Medicaid
IA1821021304Medicaid
SD6100473Medicaid
NE10025568900Medicaid
SD1821021304OtherARAZ/ AMERICA'S PPO
SD41161OtherDAKOTACARE
MN46L91PUOtherCC SYSTEMS/ BLUE PLUS
SDHP43169OtherHEALTHPARTNERS
SD232615OtherMIDLANDS CHOICE
SD4992697OtherBLUE CROSS
C83141030612OtherPREFERRED ONE
SD57105AT03OtherWPS TRICARE
SD6100473Medicaid
IA1821021304Medicaid