Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 65452 | MN |
N | 208000000X | Pediatrician | 74419 | WI |
N | 208000000X | Pediatrician | OS015978 | PA |
N | 2080P0216X | Pediatric Rheumatologist | OP.60632322 | WA |
NPI | 1689800260 |
---|---|
Provider Name | Matthew Basiaga |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 15/07/2021 |