Healthcare Provider Details

I. General information

NPI: 1689641771
Provider Name (Legal Business Name): DOUGLAS N HOTVEDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NICOLLET AVE S - MAIL STOP 31500A HEALTHPARTNERS BLOOMINGTON CLINIC
BLOOMINGTON MN
55440-1309
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-541-2800
  • Fax: 952-886-7015
Mailing address:
  • Phone: 952-883-5375
  • Fax: 952-886-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33778
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: