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NPI Code Detail

MEDICARE: BRANDON CHRISTOPHER BADER

MEDICARE:   BRANDON CHRISTOPHER BADER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1874647200OTHERMN874647200

General Provider Information

NPI Number : 1154947901
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON CHRISTOPHER BADER
Provider Business Mailing Address
First Line : 2800 FREEWAY BLVD STE 204
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55430-1751
Country : US
Telephone Number : 763-412-1996
Fax Number : 763-292-5653
Provider Business Practice Location Address
First Line : 2800 FREEWAY BLVD STE 204
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55430-1751
Country : US
Telephone Number : 763-412-1996
Fax Number : 763-292-5653
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2020
Last Update Date : 06/17/2020

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Directions to “ BRANDON CHRISTOPHER BADER ” Practice Location

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