Provider Demographics
NPI:1225066681
Name:BACHMAN, PHILIP JENNINGS (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JENNINGS
Last Name:BACHMAN
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 1:204 9TH AVE NORTH EAST
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:MN
Mailing Address - Zip Code:56367
Mailing Address - Country:US
Mailing Address - Phone:320-227-2595
Mailing Address - Fax:320-393-4714
Practice Address - Street 1:204 9TH AVE NE
Practice Address - Street 2:
Practice Address - City:RICE
Practice Address - State:MN
Practice Address - Zip Code:56367-4605
Practice Address - Country:US
Practice Address - Phone:320-227-2595
Practice Address - Fax:320-393-4714
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0284855207Q00000X
MN284852083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN373782900Medicaid
MN373782900Medicaid
MN089004119Medicare PIN