Provider Demographics
NPI:1225219967
Name:HEDEMARK, LINDA LEAH (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LEAH
Last Name:HEDEMARK
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 1:27 CROCUS PL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2810
Mailing Address - Country:US
Mailing Address - Phone:651-227-1246
Mailing Address - Fax:
Practice Address - Street 1:15245 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:CENTER CITY
Practice Address - State:MN
Practice Address - Zip Code:55012-9640
Practice Address - Country:US
Practice Address - Phone:651-213-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23045171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor