Provider Demographics
NPI:1073749974
Name:BAZILE, EMILIO (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:BAZILE
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 1:2000 KLEIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-5800
Mailing Address - Country:US
Mailing Address - Phone:507-933-5011
Mailing Address - Fax:
Practice Address - Street 1:2000 KLEIN ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-5800
Practice Address - Country:US
Practice Address - Phone:507-933-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN466622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry