Provider Demographics
NPI:1821081068
Name:DR VM BAICH PA
Entity Type:Organization
Organization Name:DR VM BAICH PA
Other - Org Name:BAICH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VELEMIR
Authorized Official - Last Name:BAICH
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:218-245-1484
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:101 BAICH DR
Mailing Address - City:COLERAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55722-0198
Mailing Address - Country:US
Mailing Address - Phone:218-245-1484
Mailing Address - Fax:218-245-1522
Practice Address - Street 1:101 BAICH DR
Practice Address - Street 2:
Practice Address - City:COLERAINE
Practice Address - State:MN
Practice Address - Zip Code:55722
Practice Address - Country:US
Practice Address - Phone:218-245-1484
Practice Address - Fax:218-245-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:2007-05-08
Deactivation Code:
Reactivation Date:2007-05-21
Provider Licenses
StateLicense IDTaxonomies
MN20782207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1010219OtherPREFERRED ONE
MN70140BAOtherBCBS
MN1700807OtherMEDICA
MN1010219OtherPREFERRED ONE