Provider Demographics
NPI:1841266608
Name:LONGO, CHARLES A (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:LONGO
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 1:2400 S MINNESOTA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1315 S. CLIFF AVE
Practice Address - Street 2:STE 3000
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1061
Practice Address - Country:US
Practice Address - Phone:605-322-7600
Practice Address - Fax:605-322-7601
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5192207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1909119OtherARAZ/ AMERICA'S PPO
SD240862OtherMIDLANDS CHOICE
NE46022474351Medicaid
IA0574087Medicaid
IA20762OtherBLUE CROSS
SD4995936OtherBLUE CROSS
SD5192OtherDAKOTACARE
MN028917500Medicaid
SD6004720Medicaid
SD57105Y004OtherWPS TRICARE
SDHP40616OtherHEALTHPARTNERS
SD34596OtherSANFORD HEALTH PLAN
SDP00095104OtherRR MEDICARE
MN157L6LOOtherCC SYSTEMS/ BLUE PLUS
MN157L6LOOtherBLUE CROSS
SD309991034635OtherPREFERRED ONE
SD3300147OtherMEDICA
SDS41542Medicare PIN
SD309991034635OtherPREFERRED ONE
IA0574087Medicaid