Provider Demographics
NPI:1548261357
Name:JAGELSKI, AARON THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:THOMAS
Last Name:JAGELSKI
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-0052
Mailing Address - Country:US
Mailing Address - Phone:307-949-0242
Mailing Address - Fax:
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-755-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253895207Q00000X, 208M00000X
MN58593207Q00000X, 208M00000X
WY5242A207Q00000X
IDM9101207Q00000X
ORMD25187207Q00000X
AZ56358207Q00000X
WI111-320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1132186Medicare PIN
G01420Medicare UPIN
ID1132185Medicare PIN
ORR140589Medicare PIN
ID1132184Medicare PIN
ORR146638Medicare PIN
ORR120329Medicare PIN
ORR140588Medicare PIN