Organization
BASHIOUM COSMETIC SURGERY CENTER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RALPH W BASHIOUM MD (PRESIDENT)
(952) 449-4900
Entity
Organization
Contact information
Practice address
445 LAKE ST E STE 210, WAYZATA, MN 55391-1671
(952) 449-4900
(952) 449-9531
Mailing address
2854 HIGHWAY 55, SUITE 130, EAGAN, MN 55121-2156
(952) 449-4900
(952) 449-9531
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
09/24/2013
Last updated
01/16/2014
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