Provider Demographics
NPI:1962439182
Name:PERSON, MICHAEL ALLEN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:PERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:A
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:911 E 20TH ST
Mailing Address - Street 2:STE 700
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1049
Mailing Address - Country:US
Mailing Address - Phone:605-334-0393
Mailing Address - Fax:605-334-6028
Practice Address - Street 1:911 E. 20TH ST
Practice Address - Street 2:STE 700
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1049
Practice Address - Country:US
Practice Address - Phone:605-334-0393
Practice Address - Fax:605-334-6028
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-36886208600000X
SD7546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1172303Medicare UPIN