Provider Demographics
NPI:1346230034
Name:WILLARDSEN, DARIN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:DAVID
Last Name:WILLARDSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41771207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1022874OtherPREFERRED ONE
2116582OtherFIRST HEALTH PLAN
HP30227OtherHEALTH PARTNERS
0401366OtherMEDICA HEALTH PLANS
MN305475600Medicaid
1085338OtherARAZ GROUP/AMERICA'S PPO
127719OtherU-CARE
305475600OtherMEDICAL ASSISTANCE
81D75WIOtherBLUE CROSS BLUE SHIELD
127719OtherU-CARE
H22145Medicare UPIN