Individual
FARES YOUSEF MASANNAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6709 S MINNESOTA AVE, SUITE 102, SIOUX FALLS, SD 57108-2592
(605) 335-1952
(605) 373-9971
Mailing address
6709 S MINNESOTA AVE STE 102, SIOUX FALLS, SD 57108-2593
(605) 322-7250
(605) 331-6401
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PG PERMIT # 76497
AZ
207RI0200X
Infectious Disease Physician
Primary
7518
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6632250
—
SD
01
—
RAILROAD MEDICARE
P00751793
SD
Enumeration date
06/18/2007
Last updated
08/06/2014
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