MEDICARE: MAREN KELLY NESS GAUL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	12230	SD

General Provider Information

NPI Number	:	1699061085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAREN KELLY NESS GAUL D.O.

Provider Business Mailing Address
First Line	:	705 COLUMBUS ST FL 2
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3623
Country	:	US
Telephone Number	:	605-600-8380
Fax Number	:	605-939-7223

Provider Business Practice Location Address
First Line	:	705 COLUMBUS ST FL 2
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3623
Country	:	US
Telephone Number	:	605-600-8380
Fax Number	:	605-939-7223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	01/16/2026

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