Individual
BRADLEY E BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4730 CHICAGO AVE, MINNEAPOLIS, MN 55407-3570
(612) 313-0000
(612) 313-0004
Mailing address
PO BOX 1309, MSIAL STOP 21110Q, MINNEAPOLIS, MN 55440-1309
(612) 313-0000
(612) 313-0004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10829
MN
Other
Enumeration date
07/07/2006
Last updated
12/27/2016
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