Healthcare Provider Details

I. General information

NPI: 1407937766
Provider Name (Legal Business Name): ANGELICA BADARU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

4500 SAND POINT WAY NE #100
SEATTLE WA
98105-3900
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax: 612-365-8001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD00046071
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number62953
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: