Provider Demographics
NPI:1154388676
Name:FAUSCH, MARK D (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:FAUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4275207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
24696OtherHEALTH PARTNERS
25-00470OtherMEDICA SELECTCARE
IA24749OtherIA BCBS
SD4275OtherDAKOTACARE
IA0501205Medicaid
MN89A46FAOtherMN BCBS - PLAN 91057NO
132666OtherUCARE
SD6003430Medicaid
MN931451029032OtherPREFERRED ONE
MN422522800Medicaid
SD4998788OtherSD BCBS
MNMN BLUE SHIELDOther497L2FA
MN89A46FAOtherMN BCBS - PLAN 91057NO
SD4998788OtherSD BCBS
SDC81475Medicare UPIN
SD6003430Medicaid