Provider Demographics
NPI:1235133612
Name:RATH, GEORGE DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DANIEL
Last Name:RATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9556
Mailing Address - Fax:605-328-9501
Practice Address - Street 1:400 N HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-5800
Practice Address - Country:US
Practice Address - Phone:605-987-4378
Practice Address - Fax:605-987-5844
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5608343Medicaid
SDS40938Medicare PIN
IA080193560Medicare PIN
SD080193564Medicare PIN
IAI9250Medicare PIN
SD5608343Medicaid