Healthcare Provider Details

I. General information

NPI: 1801826979
Provider Name (Legal Business Name): HEIDI HUSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 BANDANA BLVD W
SAINT PAUL MN
55108-5107
US

IV. Provider business mailing address

1021 BANDANA BLVD E SUITE 200
SAINT PAUL MN
55108-5113
US

V. Phone/Fax

Practice location:
  • Phone: 651-641-7000
  • Fax: 651-641-7166
Mailing address:
  • Phone: 651-642-2700
  • Fax: 651-642-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40961
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: