Healthcare Provider Details

I. General information

NPI: 1871117549
Provider Name (Legal Business Name): ASHLESHA RAVINDRA BAGWE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number82465
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: