MEDICARE: DR. PAUL B. BANDELIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	50184-21	WI
2	207N00000X	Dermatology Physician	60390	MN
3	207N00000X	Dermatology Physician	50184-21	WI

General Provider Information

NPI Number	:	1497805071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL B. BANDELIN DO

Provider Business Mailing Address
First Line	:	1230 E MAIN ST
Second Line	:	PO BOX 8674
City	:	MANKATO
State	:	MN
Zip	:	56001-5066
Country	:	US
Telephone Number	:	507-625-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 SUNRISE DR
Second Line	:	SUITE 300
City	:	SAINT PETER
State	:	MN
Zip	:	56082-5376
Country	:	US
Telephone Number	:	507-389-8538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/22/2020

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