Provider Demographics
NPI:1801873047
Name:HANDRIGAN, JANET MARY (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MARY
Last Name:HANDRIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1520 WHITNEY CT
Mailing Address - Street 2:CENTRA CARE CLINIC
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1899
Mailing Address - Country:US
Mailing Address - Phone:320-251-1775
Mailing Address - Fax:507-434-1477
Practice Address - Street 1:1520 WHITNEY CT
Practice Address - Street 2:CENTRA CARE CLINIC
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1899
Practice Address - Country:US
Practice Address - Phone:320-251-1775
Practice Address - Fax:507-434-1477
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN41631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN554813600Medicaid
MN080136143OtherMEDICARE RAILROAD
H05400Medicare UPIN
MN080007918Medicare ID - Type Unspecified
MN554813600Medicaid