# OBGYN SPECIALTY CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760664502
- **Authorized official:** ELIZABETH DIMITRIEVICH MD (PRESIDENT)
- **Authorized official phone:** (605) 338-0836

## Contact information

- **Practice address:** 625 W 18TH ST, SIOUX FALLS, SD 57105
- **Practice address phone:** (605) 338-0836
- **Practice address fax:** (605) 338-7890
- **Mailing address:** 625 W 18TH ST, SIOUX FALLS, SD 57105
- **Mailing address phone:** (605) 338-0836
- **Mailing address fax:** (605) 338-7890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 3478 | SD | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 04/11/2011