Healthcare Provider Details

I. General information

NPI: 1568396265
Provider Name (Legal Business Name): INAYAT BACHELANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 BROADWAY ST NE
MINNEAPOLIS MN
55413-2151
US

IV. Provider business mailing address

636 BROADWAY ST NE
MINNEAPOLIS MN
55413-2151
US

V. Phone/Fax

Practice location:
  • Phone: 612-746-1530
  • Fax:
Mailing address:
  • Phone: 612-746-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD15469
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: