Basic Information
| Provider Information | |||||||||
| NPI: | 1194836510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEDLUND | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 S ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | SAINT CROIX FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540249449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154830429 | ||||||||
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| Practice Location | |||||||||
| Address1: | 265 GRIFFIN ST E | ||||||||
| Address2: | |||||||||
| City: | AMERY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152688000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26989 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 27G36HE | 01 | MN | BLUE CROSS MN FACILITY | OTHER | 265785600 | 05 | MN | MEDICAID | 0113859 | 01 | MEDICA | OTHER | HP10579 | 01 | HEALTHPARTNERS | OTHER | 30821200 | 05 | WI | MEDICAID | NA9030224032 | 01 | PREFERREDONE | OTHER | 080099987 | 01 | RAILROAD | OTHER | 64Q28HE | 01 | MN | BLUE CROSS MN PRO FEE | OTHER |