Bashioum Cosmetic Surgery Center, LTD.

Organization Active NPI Plastic Surgery Physician · Wayzata, MN

NPI 1104252022 · NPPES record last updated Jan 16, 2014

Key facts

NPI
1104252022
Entity type
Organization (NPI type 2)
Primary specialty
Plastic Surgery Physician 208200000X
Legal business name
BASHIOUM COSMETIC SURGERY CENTER, LTD.
Practice address
445 Lake St E Ste 210
Wayzata, MN 55391-1671
Phone
(952) 449-4900
Fax
(952) 449-9531
NPI assigned
Sep 24, 2013
Organization subpart
No

Authorized official

Name
Dr. Ralph W Bashioum, MD
Title
President
Phone
(952) 449-4900

National Provider Directory

Locations

445 Lake St E
Ste 210
Wayzata, MN 55391
Phone (952) 449-4900

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician
Group: 193400000X SINGLE SPECIALTY GROUP
208200000X Yes

Addresses

Primary practice location

445 Lake St E Ste 210
Wayzata, MN 55391-1671

Mailing address

2854 Highway 55
Suite 130
Eagan, MN 55121-2156
Phone (952) 449-4900

Other providers in Wayzata, MN

All providers in Wayzata, MN · Plastic Surgery Physician in Minnesota

Sources for this page

Verify at the official NPI Registry.