Healthcare Provider Details

I. General information

NPI: 1841547387
Provider Name (Legal Business Name): HANS BJELLUM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 19TH AVE N SUITE L&M
FARGO ND
58102-5906
US

IV. Provider business mailing address

1100 19TH AVE N SUITE L&M
FARGO ND
58102-5906
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-2909
  • Fax: 701-364-9346
Mailing address:
  • Phone: 701-364-2909
  • Fax: 701-364-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HANS E BJELLUM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 701-364-2909