Individual
PAUL L HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
032152
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106054
MEDICA #
MN
01
—
0106545
MEDICA #
MN
01
—
10440
NDBS #
MN
01
—
108034
UCARE #
MN
05
—
16005
—
MN
01
—
2223
SIOUX VALLEY #
MN
01
—
28232HE
MNBS #
MN
05
—
300793600
—
MN
01
—
901108
AMERICA'S PPO/ARAZ #
MN
01
—
DA9031015654
PREFERRED ONE #
MN
01
—
HP19489
HEALTHPARTNERS #
MN
01
—
MN1000020
LHS/BANNERHEALTH #
MN
Enumeration date
06/08/2006
Last updated
11/21/2011
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