Provider Demographics
NPI:1871691295
Name:SUNDELL, BRIDGET ANN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ANN
Last Name:SUNDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2339
Mailing Address - Country:US
Mailing Address - Phone:218-741-4411
Mailing Address - Fax:218-741-8966
Practice Address - Street 1:602 N 6TH AVE W
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-5579
Practice Address - Country:US
Practice Address - Phone:218-741-4111
Practice Address - Fax:218-741-8966
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44402OtherSTATE MEDICAL LICENSE NUM
MN033709900Medicaid
MN44402OtherSTATE MEDICAL LICENSE NUM
MN180001057Medicare ID - Type Unspecified
MN180001057Medicare PIN