Provider Demographics
NPI:1861467219
Name:KORSTAD, HEIDI JEAN (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JEAN
Last Name:KORSTAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 PINE TREE DRIVE
Mailing Address - Street 2:PO BOX 135
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628
Mailing Address - Country:US
Mailing Address - Phone:218-743-3232
Mailing Address - Fax:218-743-4223
Practice Address - Street 1:135 PINE TREE DRIVE
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628
Practice Address - Country:US
Practice Address - Phone:218-743-3232
Practice Address - Fax:218-743-4223
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN27893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN72222OtherMPIN
MND48715Medicare UPIN