Provider Demographics
NPI:1275577371
Name:BASS, DEANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:BASS
Suffix:
Gender:F
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-273-9800
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP15843OtherHEALTHPARTNERS
MN055803600Medicaid
MN1001013OtherPREFERRED ONE
MN15-60430OtherMEDICA CHOICE
WI31785900Medicaid
MN36Q97BAOtherBCBS PHALEN
MN768010OtherARAZ
MT0055641Medicaid
IA2538157Medicaid
MN106109OtherUCARE
MN15-83243OtherMEDICA
MN25-70708Medicaid
MN36Q99BAOtherBCBS BETHESDA
MN055803600Medicaid
MN25-70708Medicaid
MT0055641Medicaid