Provider Demographics
NPI:1053364091
Name:MARCKSTADT, GARY STEVEN (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:STEVEN
Last Name:MARCKSTADT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6110 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2549
Mailing Address - Country:US
Mailing Address - Phone:605-332-2883
Mailing Address - Fax:605-328-5831
Practice Address - Street 1:900 E 54TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0686
Practice Address - Country:US
Practice Address - Phone:605-332-2883
Practice Address - Fax:605-328-5831
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD3887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS41075Medicare PIN
G11256Medicare UPIN