Provider Demographics
NPI:1548253388
Name:SANDVIK, DAVID E (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:SANDVIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 SAINT JOSEPH ST
Mailing Address - Street 2:SUITE B100
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2414
Mailing Address - Country:US
Mailing Address - Phone:605-718-4380
Mailing Address - Fax:605-718-4396
Practice Address - Street 1:909 SAINT JOSEPH ST
Practice Address - Street 2:SUITE B100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2414
Practice Address - Country:US
Practice Address - Phone:605-718-4380
Practice Address - Fax:605-718-4396
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD207RG0300X207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6000642Medicaid
SDD25588Medicare UPIN
SD40055Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER