Provider Demographics
NPI:1164698569
Name:HIDESTRAND, PIP (MD)
Entity Type:Individual
Prefix:
First Name:PIP
Middle Name:
Last Name:HIDESTRAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PIP
Other - Middle Name:M
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-8885
Mailing Address - Fax:207-973-8817
Practice Address - Street 1:417 STATE ST STE 305
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6654
Practice Address - Country:US
Practice Address - Phone:207-973-8585
Practice Address - Fax:207-973-8817
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD205552080P0202X, 2080P0202X
WI537162080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164698569Medicaid
WI680860876Medicare PIN
WI736012121Medicare PIN