Healthcare Provider Details

I. General information

NPI: 1104860279
Provider Name (Legal Business Name): MACARAN ALEXANDER BAIRD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E 28TH ST. UMPHYSICIANS SMILEY'S CLINIC
MINNEAPOLIS MN
55407
US

IV. Provider business mailing address

720 WASHINGTON AVE SE UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55414
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-0770
  • Fax: 612-333-1986
Mailing address:
  • Phone: 612-884-0649
  • Fax: 612-676-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22663
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: