Provider Demographics
NPI:1245419134
Name:DAUGELA, LINA (MD PHD)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:DAUGELA
Suffix:
Gender:F
Credentials:MD PHD
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:CENTRACARE CLINIC ST CLOUD MEDICAL GROUP NORTHWEST
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4872
Mailing Address - Country:US
Mailing Address - Phone:320-202-8949
Mailing Address - Fax:320-257-1733
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:CENTRACARE CLINIC ST CLOUD MEDICAL GROUP NORTHWEST
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4872
Practice Address - Country:US
Practice Address - Phone:320-202-8949
Practice Address - Fax:320-257-1733
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2021-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN51890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12083Medicaid
MN80022948Medicare PIN