1821021304 NPI number — MICHAEL RICARD PUUMALA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821021304 NPI number — MICHAEL RICARD PUUMALA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PUUMALA

Provider First Name:

MICHAEL

Provider Middle Name:

RICARD

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1821021304

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/16/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 86370

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SIOUX FALLS

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57118-6370

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-322-7510

Provider Business Mailing Address Fax Number:

605-322-6475

Provider First Line Business Practice Location Address:

1301 S. CLIFF AVE

Provider Second Line Business Practice Location Address:

STE 610

Provider Business Practice Location Address City Name:

SIOUX FALLS

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57105-1032

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-322-8860

Provider Business Practice Location Address Fax Number:

605-322-8868

Provider Enumeration Date:

07/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207T00000X , with the licence number:  4116 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 820816600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1821021304 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 6100473 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 10025568900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 1821021304 . This is a "ARAZ/ AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 41161 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 46L91PU . This is a "CC SYSTEMS/ BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP43169 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 232615 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4992697 . This is a "BLUE CROSS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: C83141030612 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
• Identifier: 57105AT03 . This is a "WPS TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".