Individual
BRADLEY G VANTATENHOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8100 NORTHLAND DR, BLOOMINGTON, MN 55431-4800
(952) 831-8742
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15272
MN
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
12/12/2024
Last updated
02/19/2025
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