Provider Demographics
NPI:1720040405
Name:ELIASON, SANDRA HAGER (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:HAGER
Last Name:ELIASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:HAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-6099
Mailing Address - Fax:612-273-6461
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-6099
Practice Address - Fax:612-273-6461
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN08F21ELOtherBCBS OF MN
MN6603848OtherMEDICA UC
MN107288OtherUCARE MN
MN0190013OtherPREFERRED ONE
MN0107538OtherMEDICA
MN473003800Medicaid
MNHP19872OtherHEALTHPARTNERS
MN21529OtherAMERICA'S PPO
MN080079424Medicare ID - Type UnspecifiedMEDICARE RR
MN107288OtherUCARE MN
MN08F21ELOtherBCBS OF MN