Provider Demographics
NPI:1528355740
Name:VANDYKE, ASHLEY J (DO)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:J
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86430
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6430
Mailing Address - Country:US
Mailing Address - Phone:605-322-4900
Mailing Address - Fax:605-322-4910
Practice Address - Street 1:6215 SOUTH CLIFF AVENUE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8589
Practice Address - Country:US
Practice Address - Phone:605-322-3300
Practice Address - Fax:605-322-3301
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD9196207Q00000X
IA4319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1528355740Medicaid