| Organization Name: | HEIDE'S MASTECTOMY SERVICES OF DULUTH. |
| NPI Number: | 1851474506 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHLEEN R WRAZIDLO (OWNER) |
| Mailing Address: | 701 1/2 North 6th Ave. East Duluth |
| State: | MN US |
| Postal Code: | 558051333 |
| Phone Number: | 2187227860 |
| Fax Number: | 2187227872 |
| NPI Enumeration Date: | 10/23/2006 |
| NPI Last Update Date: | 09/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |