Healthcare Provider Details

I. General information

NPI: 1265721757
Provider Name (Legal Business Name): YAUHEN ALEXANDER TARBUNOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE. N.
ST. CLOUD MN
56303-2735
US

IV. Provider business mailing address

2945 HAZELWOOD ST STE 300
MAPLEWOOD MN
55109-1244
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-3342
  • Fax: 320-252-3501
Mailing address:
  • Phone: 651-232-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number13822-320
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number63903
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD56545
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number24066
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME179290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: