Provider Demographics
NPI:1679554745
Name:HELLER, PATRICK JOEL (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOEL
Last Name:HELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:525 MAIN ST W
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM - MELROSE
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1043
Mailing Address - Country:US
Mailing Address - Phone:320-256-4228
Mailing Address - Fax:320-256-7106
Practice Address - Street 1:525 MAIN ST W
Practice Address - Street 2:CENTRACARE HEALTH SYSTEM - MELROSE
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1043
Practice Address - Country:US
Practice Address - Phone:320-256-4228
Practice Address - Fax:320-256-7106
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN40714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
340K5HEOtherBLUE CROSS BLUE SHIELD
MN841508100Medicaid
830085OtherARAZ GROUP AMERICAS PPO
0118377OtherMEDICA HEALTH PLANS
47A46CEOtherBLUE CROSS BLUE SHIELD
1017079OtherPREFERRED ONE
122999OtherU CARE
G76491Medicare UPIN
MN841508100Medicaid
0118377OtherMEDICA HEALTH PLANS
122999OtherU CARE