Organization
HEIDE'S MASTECTOMY SERVICES OF DULUTH.
Active
Other names
Heide's
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN R WRAZIDLO (OWNER)
(218) 722-7860
Entity
Organization
Contact information
Practice address
701 1/2 NORTH 6TH AVE. EAST, DULUTH, MN 55805-1333
(218) 722-7860
(218) 722-7872
Mailing address
701 1/2 NORTH 6TH AVE. EAST, DULUTH, MN 55805-1333
(218) 722-7860
(218) 722-7872
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
N/A
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011560
PREFERRED ONE
MN
01
—
3833743
BCBS
MN
01
—
41166285019
BCBS
WI
05
—
41665200
—
WI
01
—
60724
HEALTH PARTNERS
MN
05
—
784363100
—
MN
01
—
8211003
MEDICA
MN
Enumeration date
10/23/2006
Last updated
09/09/2008
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