Provider Demographics
NPI:1093779100
Name:BACHAN, PETR (MD)
Entity Type:Individual
Prefix:
First Name:PETR
Middle Name:
Last Name:BACHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-254-7676
Practice Address - Street 1:401 PHALEN BLVD - MS 41102D
Practice Address - Street 2:HEALTHPARTNERS SPECIALTY CENTER 401
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7670
Practice Address - Fax:651-254-7676
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-12-07
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Provider Licenses
StateLicense IDTaxonomies
MN46516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG84505Medicare UPIN