Individual
MICHAEL R BIRGENHEIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
814 JACKSON ST, BURKE, SD 57523-0358
(605) 775-2361
Mailing address
814 JACKSON ST, BURKE, SD 57523-0358
(605) 775-2631
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1012584
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27748
SIOUX VALLEY
SD
01
—
4997170
BC/BS
SD
01
—
505068706
NE MEDICAID
NE
05
—
6823712
—
SD
Enumeration date
06/05/2006
Last updated
04/18/2008
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