Basic Information
| Provider Information | |||||||||
| NPI: | 1750357299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S. MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E. 23RD ST. | ||||||||
| Address2: | STE. 230 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571052122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226900 | ||||||||
| FaxNumber: | 6053226901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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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 | 5612 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4994628 | 01 | SD | BLUE CROSS | OTHER | 0593988 | 05 | IA | MEDICAID | 146682800 | 05 | MN | MEDICAID | 377G1HU | 01 | MN | BLUE CROSS | OTHER | 6005140 | 05 | SD | MEDICAID | 57105V007 | 01 | SD | WPS TRICARE | OTHER | HP52503 | 01 | SD | HEALTHPARTNERS | OTHER | 377G1HU | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 92411422903 | 01 | MN | PRIMEWEST | OTHER | P00269053 | 01 | SD | RR MEDICARE | OTHER | 3600589 | 01 | SD | MEDICA | OTHER | 5612 | 01 | SD | DAKOTACARE | OTHER | 2361646 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 246830 | 01 | SD | MIDLANDS CHOICE | OTHER | 407191020165 | 01 | SD | PREFERRED ONE | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 45374 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 46022474336 | 05 | NE | MEDICAID |