Provider Demographics
NPI:1861465718
Name:HERMANSEN, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:HERMANSEN
Suffix:
Gender:M
Credentials:MD
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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:651-254-9426
Practice Address - Street 1:640 JACKSON ST - MAIL STOP 11302C
Practice Address - Street 2:HEALTHPARTNERS REGIONS BEHAVIORAL HEALTH-ST.PAUL
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4786
Practice Address - Fax:651-254-9426
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN310932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN518807500Medicaid
MN260001433Medicare ID - Type Unspecified
B40451Medicare UPIN