Individual
DR. ANDREA KIRSTIN BACANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4403 HARRISON BLVD, STE 3650, OGDEN, UT 84403-3271
(801) 387-7125
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-7125
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
34524
AZ
207RR0500X
Rheumatology Physician
103872
MN
207RR0500X
Rheumatology Physician
51043
MN
207RR0500X
Rheumatology Physician
Primary
8027519-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223832
—
AZ
05
—
ENROLLED
—
MN
01
—
P00728951
RAILROAD MEDICARE
MN
Enumeration date
11/30/2005
Last updated
08/31/2011
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