Healthcare Provider Details

I. General information

NPI: 1477408151
Provider Name (Legal Business Name): BENJAMIN BAUER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BROADWAY ST NE
MINNEAPOLIS MN
55413-2195
US

IV. Provider business mailing address

3001 BROADWAY ST NE
MINNEAPOLIS MN
55413-2195
US

V. Phone/Fax

Practice location:
  • Phone: 763-228-8305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number242965-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: