Provider Demographics
NPI:1588746515
Name:BADBERG, AMY MARGRETA (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARGRETA
Last Name:BADBERG
Suffix:
Gender:F
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 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-9802
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1242
Practice Address - Country:US
Practice Address - Phone:712-324-5356
Practice Address - Fax:712-324-6515
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2197764Medicaid
IA0638593Medicaid
IA0254656Medicaid
IA168506Medicare ID - Type UnspecifiedRHC # SHELDON
IA0254656Medicaid
IA42047Medicare ID - Type UnspecifiedPART B GROUP #
IA2197764Medicaid
IA163875AMedicare ID - Type UnspecifiedRHC # SANBORN