Provider Demographics
NPI:1760497150
Name:HASSELL, DOUGLASS S (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLASS
Middle Name:S
Last Name:HASSELL
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 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN495352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34782500Medicaid
MN9250227OtherDAKOTA CARE
MN960371050685OtherPREFERRED ONE
MN1760497150OtherMEDICA
MN417OtherAMERICA'S PPO
MN818185000Medicaid
MN134181OtherUCARE
MN1376558205OtherPHCS/MULTIPLAN
MN253803OtherMIDLANDS CHOICE INC
MN828K5HAOtherBLUE CROSS AND BLUE SHIELD OF MN
MNHP78030OtherHEALTHPARTNERS
IA1376558205Medicaid
MNP00398841OtherRAILROAD MEDICARE MN
MNHP78030OtherHEALTHPARTNERS
MNP00398841OtherRAILROAD MEDICARE MN
IA1376558205Medicaid
MN300004163Medicare PIN
MN161255Medicare UPIN
MN300004161Medicare PIN