Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2332 | ND |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 15017 | ND |
N | 204E00000X | Oral & Maxillofacial Surgeon | 32072 | AZ |
N | 204E00000X | Oral & Maxillofacial Surgeon | PT15017 | ND |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 32072 | AZ |
NPI | 1225013022 |
---|---|
Provider Name | Dr. Karel A Deleeuw |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Fargo, ND 58103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
816936 | (05) | AZ |
86080015085259C381 | TRIWEST (01) | AZ |
E07830 | (02) | |
P00150696 | RAILROAD MEDICARE (01) | AZ |