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NPI Code Detail

MEDICARE: DR. PAUL S BAGDADE PH.D., L.P.

MEDICARE: DR. PAUL S BAGDADE PH.D., L.P.
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
1103TC0700XClinical PsychologistLP 4527MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2HP48607OTHERMNHEALTH PARTNERS
3519T2BAOTHERMNBCBS

General Provider Information

NPI Number : 1699785196
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL S BAGDADE PH.D., L.P.
Provider Business Mailing Address
First Line : 2945 HAZELWOOD ST STE 200
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-1243
Country : US
Telephone Number : 612-440-6315
Fax Number : 651-412-5338
Provider Business Practice Location Address
First Line : 2945 HAZELWOOD ST STE 200
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-1243
Country : US
Telephone Number : 612-440-6315
Fax Number : 651-412-5338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 05/14/2025

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