Individual
DR. KIMBERLY SUSAN BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1347 LARPENTEUR AVE W, FALCON HEIGHTS, MN 55113-6302
(651) 558-2020
(651) 487-2369
Mailing address
1347 LARPENTEUR AVE W, FALCON HEIGHTS, MN 55113-6302
(651) 558-2020
(651) 487-2369
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
34550
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00375969
RAILROAD MEDICARE
MN
Enumeration date
10/27/2006
Last updated
02/19/2009
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