Provider Demographics
NPI:1235102658
Name:HULT, CHRISTINE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:HULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2635 UNIVERSITY AVE
Practice Address - Street 2:SUITE 160 MAIL STOP 13901B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1271
Practice Address - Country:US
Practice Address - Phone:651-254-3500
Practice Address - Fax:651-254-3699
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN26403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN396380200Medicaid
A95758Medicare UPIN
MN396380200Medicaid