BW Medical PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

39788 Issued in MN

Legal business name

BW MEDICAL PA

Practice address

4001 Stinson Blvd NE
Ste 404
Minneapolis, MN 55421-3424

Phone

(612) 706-9630

Fax

(612) 706-9617

NPI assigned

Apr 19, 2012

Last updated

Apr 19, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly J. Haycraft-Williams, MD

Title

Owner

Phone

(612) 706-9630

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1962769687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17620 DURANT ST NE",
            "city": "HAM LAKE",
            "state": "MN",
            "postal_code": "553044602",
            "telephone_number": "763-413-9462",
            "fax_number": "612-706-9617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 STINSON BLVD NE",
            "address_2": "STE 404",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554213424",
            "telephone_number": "612-706-9630",
            "fax_number": "612-706-9617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BW MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-19",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "HAYCRAFT-WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-706-9630",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "39788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Lynne Butzow, MSW, LICSW
• Jenna Butzow, LICSW
• Jonathan Buus
• Joseph Buytendorp, MD
• Kirsten M Buzzell, LAMFT, LADC
• Abel O. Bwianchinga
• Brandon Byars, PA-C, ATC
• Lavaughn Marguerite Bye, MSW, LICSW
• Kerri Byers
• Kady Byington, RN

• Family Medicine Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.