Provider Demographics
NPI:1528025103
Name:GAECKLE, C THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:THOMAS
Last Name:GAECKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:THOMAS
Other - Last Name:GAECKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5009
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1393207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN538R3GAOtherMN BCBS - PLAN 538R2NO
SD6001092Medicaid
MN4T613GAOtherMN BCBS - PLAN 91057NO
MN931451029033OtherPREFERRED ONE
36112OtherHEALTH PARTNERS
IA1122911Medicaid
121283OtherUCARE
SD0000970OtherSD BCBS
SD1393OtherDAKOTACARE
IA53989OtherIA BCBS
SDS970Medicare PIN
MN931451029033OtherPREFERRED ONE
SD1393OtherDAKOTACARE