Provider Demographics
NPI:1689641771
Name:HOTVEDT, DOUGLAS N (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:N
Last Name:HOTVEDT
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:952-886-7015
Practice Address - Street 1:8600 NICOLLET AVE S - MAIL STOP 31500A
Practice Address - Street 2:HEALTHPARTNERS BLOOMINGTON CLINIC
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55440-1309
Practice Address - Country:US
Practice Address - Phone:952-541-2800
Practice Address - Fax:952-886-7015
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN33778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN502007700Medicaid
F09667Medicare UPIN
110005066Medicare ID - Type Unspecified