Provider Demographics
NPI:1447304076
Name:BISHOP, DONALD T (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:T
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E 20TH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1042
Mailing Address - Country:US
Mailing Address - Phone:605-322-2460
Mailing Address - Fax:605-322-2470
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1042
Practice Address - Country:US
Practice Address - Phone:605-322-3050
Practice Address - Fax:605-322-3051
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2648207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDB51570Medicare UPIN