Basic Information
| Provider Information | |||||||||
| NPI: | 1376585281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACHELEDT | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 EAST THIRD STREET | ||||||||
| Address2: | MCL2CRED | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558051951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187863146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | H1983 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | H1983 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | 14418 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 134295809 | 05 | TX | MEDICAID | 134295810 | 05 | TX | MEDICAID | 134295814 | 05 | TX | MEDICAID | 134295808 | 05 | TN | MEDICAID | 134295802 | 05 | TX | MEDICAID | 134295806 | 05 | TX | MEDICAID | 1376585281 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 134295804 | 05 | TX | MEDICAID | 134295811 | 05 | TX | MEDICAID | 134295812 | 05 | TX | MEDICAID | P01086535 | 01 | TX | RR MEDICARE | OTHER | 134295801 | 05 | TX | MEDICAID | 134295803 | 01 | TX | CSHCN | OTHER | 8R1495 | 01 | TX | BLUE CROSS OF TX | OTHER |