Provider Demographics
NPI:1295701522
Name:MCCAUL, KELLY GEORGE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:GEORGE
Last Name:MCCAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1000 E. 23RD ST.
Practice Address - Street 2:STE. 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2122
Practice Address - Country:US
Practice Address - Phone:605-322-3035
Practice Address - Fax:605-322-3036
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD4717207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE46022474342Medicaid
SD0007443OtherBLUE CROSS
IA0536219Medicaid
SD678061025597OtherPREFERRED ONE
MN74Q10MCOtherCC SYSTEMS/ BLUE PLUS
SD3000020OtherMEDICA
SD57105AH02OtherWPS TRICARE
MN74Q10MCOtherBLUE CROSS
SD26746OtherMIDLANDS CHOICE
SD28222OtherSANFORD HEALTH PLAN
SD1109863OtherARAZ/ AMERICA'S PPO
SD4717OtherDAKOTACARE
SD6630680Medicaid
SD820000376OtherRR MEDICARE
MN92411422911OtherPRIMEWEST
MN143425000Medicaid
SD370624200OtherDEPT OF LABOR
SDHP32347OtherHEALTHPARTNERS
MN74Q10MCOtherCC SYSTEMS/ BLUE PLUS
SD57105AH02OtherWPS TRICARE