Individual
DR. JEREMY POULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
101 TOWER RD, DAKOTA DUNES, SD 57049-5007
(605) 217-7246
(605) 217-4878
Mailing address
101 TOWER RD, DAKOTA DUNES, SD 57049-5007
(605) 217-7246
(605) 217-4878
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
20A9945
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
7794
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00454461
MEDICARE RAILROAD CARRIER
CA
Enumeration date
04/02/2007
Last updated
06/12/2025
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