Provider Demographics
NPI:1184822330
Name:MILDRED S HANSON MD PA
Entity Type:Organization
Organization Name:MILDRED S HANSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-870-1334
Mailing Address - Street 1:710 E 24TH ST
Mailing Address - Street 2:STE 403
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-870-1334
Mailing Address - Fax:612-871-0864
Practice Address - Street 1:710 E 24TH ST STE 403
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3827
Practice Address - Country:US
Practice Address - Phone:612-870-1334
Practice Address - Fax:612-871-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03252OtherMEDICARE BILLING GROUP NU
MN3118OtherHEALTH PARTNERS
MN225968100Medicaid
MN06521HAOtherBLUE CROSS BLUE SHIELD OF