Desautel, Mark Gregory
Desautel, Mark Gregory is an individual health care provider with primary practice located at 1310 W 22Nd St , Sioux Falls SD 57105-1501. He recently has 6 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Pediatric Otolaryngology, Allopathic & Osteopathic Physicians / Facial Plastic Surgery, Allopathic & Osteopathic Physicians / Otolaryngic Allergy, Allopathic & Osteopathic Physicians / Otology & Neurotology, Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Desautel, Mark Gregory can be contacted via phone (605) 328-8200.Contact Information
Primary practice address
1310 W 22Nd St
Sioux Falls SD 57105-1501
Phone: (605) 328-8200
Fax: (605) 328-8201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 4246 | South Dakota |
| Allopathic & Osteopathic Physicians / Pediatric Otolaryngology | 207YP0228X | 4246 | South Dakota |
| Allopathic & Osteopathic Physicians / Facial Plastic Surgery | 207YS0123X | 4246 | South Dakota |
| Allopathic & Osteopathic Physicians / Otolaryngic Allergy | 207YX0602X | 4246 | South Dakota |
| Allopathic & Osteopathic Physicians / Otology & Neurotology | 207YX0901X | 4246 | South Dakota |
| Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery | 207YX0905X | 4246 | South Dakota |
Profile Details
| NPI number | 1255338174 |
|---|---|
| LBN Legal business name | Desautel, Mark Gregory |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2005 |
| Last updated | Jun 11th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255338174 | NPPES |
| South Dakota | Other | 4996176 | BLUE SHIELD |
| South Dakota | MEDICAID | 8015163000 | BLUE SHIELD |
| South Dakota | MEDICAID | 6520242 | BLUE SHIELD |
| South Dakota | MEDICAID | 1986174 | BLUE SHIELD |
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