Healthcare Provider Details

I. General information

NPI: 1376585281
Provider Name (Legal Business Name): JANET ELAINE MACHELEDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

IV. Provider business mailing address

400 EAST THIRD STREET MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-3300
  • Fax:
Mailing address:
  • Phone: 218-786-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberH1983
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberH1983
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number14418
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: