Provider Demographics
NPI:1598710790
Name:HESTNESS, MARY J (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:HESTNESS
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 1:7505 METRO BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3010
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7505 METRO BLVD STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN443362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN250J9HEOtherBLUE CROSS
MN300132408OtherRAILROAD MEDICARE MN
IA0562264Medicaid
MN095709700Medicaid
MNHP35297OtherHEALTHPARTNERS
MN142764OtherUCARE
MN1031331OtherPREFERRED ONE
MN1657168OtherAMERICA'S PPO
WI34355900Medicaid
MNHP35297OtherHEALTHPARTNERS
MN1657168OtherAMERICA'S PPO
WI002256135Medicare PIN
MN142764OtherUCARE
MN1031331OtherPREFERRED ONE
WI34355900Medicaid