MEDICARE: PETER A HILGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	023875	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040000272	OTHER	MN	PTAN #

General Provider Information

NPI Number	:	1790770196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER A HILGER MD

Provider Business Mailing Address
First Line	:	7801 EAST BUSH LAKE ROAD
Second Line	:	KALEIDOSCOPE
City	:	BLOOMINGTON
State	:	MN
Zip	:	55439-3113
Country	:	US
Telephone Number	:	952-831-5773
Fax Number	:	952-831-7224

Provider Business Practice Location Address
First Line	:	7801 E BUSH LAKE RD
Second Line	:	SUITE 320
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55439-3120
Country	:	US
Telephone Number	:	952-831-5773
Fax Number	:	952-831-7224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	04/03/2014

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