MEDICARE: DR. BRIDGET ANN SUNDELL 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	207W00000X	Ophthalmology Physician	44402	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44402	OTHER	MN	STATE MEDICAL LICENSE NUM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871691295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIDGET ANN SUNDELL MD

Provider Business Mailing Address
First Line	:	602 N 6TH AVE
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2339
Country	:	US
Telephone Number	:	218-741-4411
Fax Number	:	218-741-8966

Provider Business Practice Location Address
First Line	:	602 N 6TH AVE W
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-5579
Country	:	US
Telephone Number	:	218-741-4111
Fax Number	:	218-741-8966

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/15/2023

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