Ralph W Bashioum, M.D.
Individual provider Active NPI Plastic Surgery Physician · Wayzata, MN
NPI 1194869941 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194869941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Plastic Surgery Physician 208200000X
- License
- 30397 (MN)
- Practice address
- 445 Lake St E
Wayzata, MN 55391-1657 - Phone
- (952) 449-4900
- NPI assigned
- Feb 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30397 | MN | MD | Plastic Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 30397 | MN | Yes |
Addresses
Primary practice location
445 Lake St E
Wayzata, MN 55391-1657
Mailing address
461 Peavey LN
Wayzata, MN 55391-1534
Phone (952) 743-7854
Other providers in Wayzata, MN
- Dana Theresa Bageon
- Andrea Barnes
- Cynthia Barnett
- Luqman Barre
- Bashioum Cosmetic Surgery Center, LTD.
- Basic Home Care
- Basic Home Care
- Bryce Mershon Beamish
- John Michael Patrick Bearg
- Abigail Beedle
All providers in Wayzata, MN · Plastic Surgery Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.