Basic Information
| Provider Information | |||||||||
| NPI: | 1104912849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOERAUF | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 HIGHWAY 12 | ||||||||
| Address2: | |||||||||
| City: | HETTINGER | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586397533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015676130 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 HIGHWAY 12 | ||||||||
| Address2: | |||||||||
| City: | HETTINGER | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586397530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015674561 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4742 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10773 | 01 | NC | ND BC/BS | OTHER | 4999829 | 01 | WELLMARCK OF SD | OTHER | 3018140 | 05 | WA | MEDICAID | 30786 | 01 | SIOUX VALLEY | OTHER | 45034068812 | 05 | NE | MEDICAID | 94433 | 01 | BLUE CROSS OTHER | OTHER | 7776130 | 05 | SD | MEDICAID | 123993 | 01 | ND | WORKER'S COMP | OTHER | 14678 | 05 | ND | MEDICAID |