Individual
KRISTEN BASTUG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 626-5637
Mailing address
GENERAL PEDIATRICS AND ADOLESCENT HEALTH, 1932K, 1717 DELAWARE STREET SOUTHEAST, SUITE 353, MINNEAPOLIS, MN 55414
(612) 626-3761
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
72420
MN
390200000X
Student in an Organized Health Care Education/Training Program
30076
MN
Other
Enumeration date
05/14/2019
Last updated
10/26/2022
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