Provider Demographics
NPI:1376585281
Name:MACHELEDT, JANET ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ELAINE
Last Name:MACHELEDT
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 1:400 EAST THIRD STREET
Mailing Address - Street 2:MCL2CRED
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-3146
Mailing Address - Fax:
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1983207RH0003X, 207RX0202X
ND14418207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134295809Medicaid
TX134295810Medicaid
TX134295814Medicaid
TN134295808Medicaid
TX134295802Medicaid
TX134295806Medicaid
TX1376585281OtherBLUE CROSS BLUE SHIELD
TX134295804Medicaid
TX134295811Medicaid
TX134295812Medicaid
TXP01086535OtherRR MEDICARE
TX134295801Medicaid
TX134295803OtherCSHCN
TX8R1495OtherBLUE CROSS OF TX
TN134295808Medicaid
TX134295802Medicaid
TX134295804Medicaid
TX346536YKQHMedicare PIN
TX8R1495OtherBLUE CROSS OF TX
TX134295806Medicaid
TX346536YMVQMedicare PIN
TX134295814Medicaid
TX830002345Medicare PIN
TXTXB128572Medicare PIN