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General NPI Number Information
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NPI Number | 1457302622
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Entity Type | Individual
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Provider Name | ANDREW R HETLAND M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 2331 TYLER PKWY STE 6
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City | BISMARCK
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State | ND
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Zip | 58503-0871
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Country | US
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Telephone | 701-258-6851
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 TYLER PKWY STE 6
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City | BISMARCK
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State | ND
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Zip | 58503-0871
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Country | US
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Telephone | 701-258-6851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 1696
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 11581
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License Number State | ND
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