Healthcare Provider Details

I. General information

NPI: 1649475807
Provider Name (Legal Business Name): BARRY KEITH BAINES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STINSON BLVD
MINNEAPOLIS MN
55413-2615
US

IV. Provider business mailing address

1629 W 25TH ST
MINNEAPOLIS MN
55405-2466
US

V. Phone/Fax

Practice location:
  • Phone: 612-676-3606
  • Fax: 612-676-6591
Mailing address:
  • Phone: 612-374-9526
  • Fax: 612-374-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number24234
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: