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General NPI Number Information
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NPI Number | 1851474506
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Entity Type | Organization
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Legal Business Name | HEIDE'S MASTECTOMY SERVICES OF DULUTH.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 701 1/2 NORTH 6TH AVE. EAST
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City | DULUTH
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State | MN
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Zip | 55805-1333
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Country | US
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Telephone | 218-722-7860
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Fax | 218-722-7872
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Provider Business Mailing Address
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Address Line | 701 1/2 NORTH 6TH AVE. EAST
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City | DULUTH
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State | MN
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Zip | 55805-1333
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Country | US
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Telephone | 218-722-7860
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Fax | 218-722-7872
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Authorized Official
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Title or Position | OWNER
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Name | MS. KATHLEEN R WRAZIDLO
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Credential |
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Telephone | 218-722-7860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | N/A
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License Number State | MN
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