Provider Demographics
NPI:1225046436
Name:MAHROUS, TAREK H (MD)
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:H
Last Name:MAHROUS
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 1:4520 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8148
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7205207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07327OtherBCBS
NE470780857 23Medicaid
IA1553412Medicaid
SD6005810Medicaid
SD7205OtherDAKOTACARE
NE46036096612Medicaid
NE89-00057OtherUHC
NE236601OtherMIDLAND'S CHOICE
25-02714OtherMEDICA
NE89-00057OtherUHC
H59773Medicare UPIN
279030Medicare ID - Type Unspecified
SD6005810Medicaid
IA1553412Medicaid