Provider Demographics
NPI:1003991449
Name:MCBROOM, SAUL AARRON (MD)
Entity Type:Individual
Prefix:DR
First Name:SAUL
Middle Name:AARRON
Last Name:MCBROOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3117
Mailing Address - Country:US
Mailing Address - Phone:612-545-9250
Mailing Address - Fax:
Practice Address - Street 1:21260 CHIPPENDALE AVE W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1427
Practice Address - Country:US
Practice Address - Phone:651-463-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1032683OtherPREFERRED ONE
WI34680300Medicaid
MN660303300Medicaid
HP54877OtherHEALTHPARTNERS
IA0596171Medicaid
106789OtherUCARE
634T2SAOtherBLUE CROSS BLUE SHIELD
66-08732OtherMEDICA/URGENT CARE
HP54877OtherHEALTHPARTNERS
WI34680300Medicaid