Provider Demographics
NPI:1396736443
Name:BJELLUM, HANS E (MD)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:E
Last Name:BJELLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5621 36TH AVE S UNIT 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5270
Mailing Address - Country:US
Mailing Address - Phone:701-977-9898
Mailing Address - Fax:
Practice Address - Street 1:5621 36TH AVE S UNIT 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5270
Practice Address - Country:US
Practice Address - Phone:701-977-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8067207Q00000X
MN41143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00442326OtherRR MEDICARE
0107352OtherMEDICA HEALTH PLANS
1021825OtherPREFERRED ONE
1756909OtherFIRST HEALTH PLAN
HP29758OtherHEALTH PARTNERS
559538000OtherMEDICAL ASSISTANCE
81D95BJOtherBLUE CROSS BLUE SHIELD
127724OtherU-CARE
COMPOtherMMSI
COMPOtherCHAMPUS
941144OtherARAZ GROUP AMERICAS PPO
COMPOtherONE HEALTH PLAN/GREATWEST
0107352OtherMEDICA HEALTH PLANS
HP29758OtherHEALTH PARTNERS