Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 35180 | MN |
NPI | 1265432769 |
---|---|
Provider Name | Dr. Steven D Baisch |
First Address | Minneapolis, MN 55404-4387 |
Second Address | Minneapolis, MN 55404-4387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 22/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F83849 | (02) | MN |