Provider Demographics
NPI:1194836510
Name:HEDLUND, PATRICK C (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:C
Last Name:HEDLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9449
Mailing Address - Country:US
Mailing Address - Phone:715-483-0429
Mailing Address - Fax:
Practice Address - Street 1:265 GRIFFIN ST E
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1439
Practice Address - Country:US
Practice Address - Phone:715-268-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27G36HEOtherBLUE CROSS MN FACILITY
MN265785600Medicaid
0113859OtherMEDICA
HP10579OtherHEALTHPARTNERS
WI30821200Medicaid
NA9030224032OtherPREFERREDONE
080099987OtherRAILROAD
MN64Q28HEOtherBLUE CROSS MN PRO FEE
MN64Q28HEOtherBLUE CROSS MN PRO FEE
0113859OtherMEDICA