Provider Demographics
NPI:1871704338
Name:AESTHETIC AND PLASTIC SURGERY, PA
Entity type:Organization
Organization Name:AESTHETIC AND PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNIESZKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-236-1900
Mailing Address - Street 1:11850 BLACKFOOT ST NW STE 130
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2583
Mailing Address - Country:US
Mailing Address - Phone:763-236-1900
Mailing Address - Fax:763-236-9010
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 130
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2583
Practice Address - Country:US
Practice Address - Phone:763-236-1900
Practice Address - Fax:763-236-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15852086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
92321OtherHLTH PART
131146OtherUCARE
1300140OtherMEDICA
MN131M0HAOtherBCBS
MN180700500Medicaid
MNG56467Medicare UPIN
MNC03935Medicare PIN