Provider Demographics
NPI:1699710822
Name:ZAMULKO, ALLA (MD)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:ZAMULKO
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:
Mailing Address - Fax:
Practice Address - Street 1:5019 S WESTERN AVE
Practice Address - Street 2:STE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5095
Practice Address - Country:US
Practice Address - Phone:605-328-9700
Practice Address - Fax:605-328-9701
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6004192Medicaid
SD6004193Medicaid
NE46022474331Medicaid
SD6004192Medicaid
SDS100717Medicare PIN
SDP00026230Medicare PIN
SDP00279996Medicare PIN
NE46022474331Medicaid