Basic Information
| Provider Information | |||||||||
| NPI: | 1053364091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCKSTADT | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6110 S MINNESOTA AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571082549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053322883 | ||||||||
| FaxNumber: | 6053285831 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E 54TH ST N STE 200 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571040686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053322883 | ||||||||
| FaxNumber: | 6053285831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 09/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3887 | SD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.