Individual
PHILLIP BUGANSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, OTC
Contact information
Practice address
3580 ARCADE ST, VADNAIS HEIGHTS, MN 55127-7135
(651) 968-5200
(651) 730-3750
Mailing address
4952 EMMIT DR N UNIT 2, HUGO, MN 55038-8505
(763) 355-2874
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
2389
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2389
LICENSE
MN
Enumeration date
12/28/2020
Last updated
12/28/2020
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