Bradford T Allan, M.D.
Individual provider Active NPI Diagnostic Radiology Physician · St Louis Park, MN
NPI 1568449239 · NPPES record last updated Feb 29, 2012
Key facts
- NPI
- 1568449239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 26361 (MN)
- Practice address
- 3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527 - Phone
- (952) 993-3212
- NPI assigned
- Dec 23, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Radiology Physician | 2085P0229X | 26361 | MN | |
| Diagnostic Radiology Physician | 2085R0202X | 26361 | MN | Yes |
Addresses
Primary practice location
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Mailing address
3800 Park Nicollet Blvd
Credentialing
St Louis Park, MN 55416-2527
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891080400 | Medicaid | MN |
Other providers in St Louis Park, MN
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- Salma Daud Ali
- Siciid Shire Ali
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- Gregory Allen
- Ally Group Homes LLC
- Rachel Jane Allyn
- Kathryn Michele Almquist
- Jory Aman
All providers in St Louis Park, MN · Diagnostic Radiology 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 Feb 29, 2012. 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.