Healthcare Provider Details

I. General information

NPI: 1023092434
Provider Name (Legal Business Name): CATHERINE S. BEDFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 CENTERVILLE RD
VADNAIS HEIGHTS MN
55127-3602
US

IV. Provider business mailing address

4520 CENTERVILLE RD
VADNAIS HEIGHTS MN
55127-3602
US

V. Phone/Fax

Practice location:
  • Phone: 651-426-1141
  • Fax: 651-426-1705
Mailing address:
  • Phone: 651-426-1141
  • Fax: 651-426-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35339
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: