Provider Demographics
NPI:1386738730
Name:THORNGREN, FRANK A (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:THORNGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-7533
Mailing Address - Country:US
Mailing Address - Phone:701-567-6130
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639
Practice Address - Country:US
Practice Address - Phone:701-567-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
21126OtherND BLUE CROSS/BLUE SHIELD
ND11578Medicaid
IA0553669Medicaid
25375OtherSIOUX VALLEY
NE45034068812Medicaid
SD5611200Medicaid
4997296OtherSD WELLMARK
21126OtherND BLUE CROSS/BLUE SHIELD
SD5611200Medicaid