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General NPI Number Information
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NPI Number | 1386886398
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Entity Type | Individual
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Provider Name | DEEPAK BHAI BAIRAGI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 559 CAPITOL BLVD
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City | SAINT PAUL
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State | MN
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Zip | 55103-2101
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Country | US
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Telephone | 651-232-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 ELWAY ST APT # 219
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City | SAINT PAUL
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State | MN
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Zip | 55116-3244
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Country | US
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Telephone | 216-702-5085
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 52740
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License Number State | MN
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