Provider Demographics
NPI:1881972016
Name:HILDAHL, BLAKE W (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:W
Last Name:HILDAHL
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 1:710 COMMERCE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-0001
Mailing Address - Country:US
Mailing Address - Phone:651-968-5200
Mailing Address - Fax:
Practice Address - Street 1:2620 EAGAN WOODS DR STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1138
Practice Address - Country:US
Practice Address - Phone:651-968-5200
Practice Address - Fax:651-968-5204
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57601207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery