Provider Demographics
NPI:1245286988
Name:HELLA, BRENT M (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:M
Last Name:HELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4450 31ST AVE S
Mailing Address - Street 2:STE 102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4557
Mailing Address - Country:US
Mailing Address - Phone:701-280-2033
Mailing Address - Fax:701-232-5578
Practice Address - Street 1:4450 31ST AVE S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4557
Practice Address - Country:US
Practice Address - Phone:701-280-2033
Practice Address - Fax:701-232-5578
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND8491207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21576OtherND BLUE SHIELD
ND11277Medicaid
MN162D8HEOtherMN BLUE SHIELD
04-02251OtherMEDICA
129104OtherUCARE
MN632527100Medicaid
ND8491OtherTRICARE
1020227OtherPREFERRED ONE
NDH05798OtherND WORKERS COMP
129104OtherUCARE
MN632527100Medicaid
MN162D8HEOtherMN BLUE SHIELD