Individual
DR. RALPH W BASHIOUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
445 LAKE ST E, WAYZATA, MN 55391-1657
(952) 449-4900
Mailing address
461 PEAVEY LN, WAYZATA, MN 55391-1534
(952) 743-7854
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
30397
MN
Other
Enumeration date
02/16/2007
Last updated
07/08/2007
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