Provider Demographics
NPI:1669408753
Name:SEDRA, HAZEM M (MD)
Entity type:Individual
Prefix:
First Name:HAZEM
Middle Name:M
Last Name:SEDRA
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 1:213 LABREE AVE N STE 207
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2022
Mailing Address - Country:US
Mailing Address - Phone:218-683-5137
Mailing Address - Fax:218-683-5413
Practice Address - Street 1:213 LABREE AVE N STE 207
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2022
Practice Address - Country:US
Practice Address - Phone:218-683-5137
Practice Address - Fax:218-683-5413
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP47445OtherHEALTHPARTNERS #
MN0119356OtherMEDICA #
MNDA9021042392OtherPREFERRED ONE #
MN24944OtherNDBS #
MN590610500Medicaid
MN2211190OtherAMERICA'S PPO/ARAZ #
MN37639OtherLHS/BANNERHEALTH #
MN13233Medicaid
MN137012OtherUCARE #
MN910S0SEOtherMNBS #
MNDA9021042392OtherPREFERRED ONE #
MN590610500Medicaid
MN080016582Medicare PIN