Provider Demographics
NPI:1326007469
Name:HUNTINGTON, MARK KENNETH SR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KENNETH
Last Name:HUNTINGTON
Suffix:SR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1013
Mailing Address - Country:US
Mailing Address - Phone:605-339-1783
Mailing Address - Fax:605-367-7157
Practice Address - Street 1:1115 E 20TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1013
Practice Address - Country:US
Practice Address - Phone:605-339-1783
Practice Address - Fax:605-367-7157
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611830Medicaid
G75925Medicare UPIN
SDS101321Medicare PIN