Provider Demographics
NPI:1699771352
Name:SUTTLE, ALLISON WIERDA (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:WIERDA
Last Name:SUTTLE
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:605-328-7180
Mailing Address - Fax:605-328-7177
Practice Address - Street 1:1500 W 22ND ST
Practice Address - Street 2:STE 301
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1503
Practice Address - Country:US
Practice Address - Phone:605-328-7700
Practice Address - Fax:605-328-7775
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4915207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6200934Medicaid
SD500029605Medicare PIN
SD6200934Medicaid
H44620Medicare UPIN
SDS40913Medicare PIN