Basic Information
| Provider Information | |||||||||
| NPI: | 1295701522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCAUL | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E. 23RD ST. | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571052122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053223035 | ||||||||
| FaxNumber: | 6053223036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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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 | 207RH0003X | 4717 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 46022474342 | 05 | NE | MEDICAID | 0007443 | 01 | SD | BLUE CROSS | OTHER | 0536219 | 05 | IA | MEDICAID | 678061025597 | 01 | SD | PREFERRED ONE | OTHER | 74Q10MC | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 3000020 | 01 | SD | MEDICA | OTHER | 57105AH02 | 01 | SD | WPS TRICARE | OTHER | 74Q10MC | 01 | MN | BLUE CROSS | OTHER | 26746 | 01 | SD | MIDLANDS CHOICE | OTHER | 28222 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 1109863 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 4717 | 01 | SD | DAKOTACARE | OTHER | 6630680 | 05 | SD | MEDICAID | 820000376 | 01 | SD | RR MEDICARE | OTHER | 92411422911 | 01 | MN | PRIMEWEST | OTHER | 143425000 | 05 | MN | MEDICAID | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | HP32347 | 01 | SD | HEALTHPARTNERS | OTHER |