Individual
FANG BU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 813-6711
(612) 813-7721
Mailing address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
Taxonomy
Speciality
Code
Description
License number
State
207ZP0213X
Pediatric Pathology Physician
35.133826
OH
207ZP0213X
Pediatric Pathology Physician
Primary
67836
MN
208000000X
Pediatrics Physician
2009013425
MO
208000000X
Pediatrics Physician
34989
SC
208000000X
Pediatrics Physician
35.133826
OH
390200000X
Student in an Organized Health Care Education/Training Program
MD34989
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0286662
—
OH
Enumeration date
09/04/2009
Last updated
10/06/2020
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