Provider Demographics
NPI:1497805071
Name:BANDELIN, PAUL B (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:BANDELIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E MAIN ST
Mailing Address - Street 2:PO BOX 8674
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5066
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1900 SUNRISE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-5376
Practice Address - Country:US
Practice Address - Phone:507-389-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50184-21207R00000X, 207N00000X
MN60390207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine