Provider Demographics
NPI:1174637060
Name:HATFIELD, AGNIESZKA S (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:S
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 BLACKFOOT ST NW STE 130
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2583
Mailing Address - Country:US
Mailing Address - Phone:763-236-1900
Mailing Address - Fax:763-236-9010
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 130
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2583
Practice Address - Country:US
Practice Address - Phone:763-236-1900
Practice Address - Fax:763-236-9010
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK20932086S0122X
MN443332086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180700500Medicaid
7581471OtherAETNA
MN180700500OtherMA
MN1300140OtherMEDICA
MN131146OtherUCARE
MN131MOHAOtherBLUE CROSS BLUE SHIELD
MAC03935OtherMEDICARE CORPORATION
MN92321OtherHEALTH PARTNERS
MN131MOHAOtherBLUE CROSS BLUE SHIELD
7581471OtherAETNA