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NPI Code Detail

MEDICARE: BRADFORD SKLOW MD

MEDICARE: BRADFORD SKLOW MD
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
1208600000XSurgery Physician5317240-1205UT
2208C00000XColon & Rectal Surgery Physician57096MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00039720OTHERUTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518057140
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADFORD SKLOW MD
Provider Business Mailing Address
First Line : 3433 BROADWAY ST NE STE 115
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1759
Country : US
Telephone Number : 651-312-1505
Fax Number : 612-248-2944
Provider Business Practice Location Address
First Line : 2800 CHICAGO AVE
Second Line : SUITE 300
City : MINNEAPOLIS
State : MN
Zip : 55407-1318
Country : US
Telephone Number : 651-225-7855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 02/27/2018

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Directions to “ BRADFORD SKLOW MD” Practice Location

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