Provider Demographics
NPI:1952333296
Name:BASTIAN, BRADLEY E (PA-C)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:E
Last Name:BASTIAN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MSIAL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:612-313-0000
Mailing Address - Fax:612-313-0004
Practice Address - Street 1:4730 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3570
Practice Address - Country:US
Practice Address - Phone:612-313-0000
Practice Address - Fax:612-313-0004
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-12-27
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Provider Licenses
StateLicense IDTaxonomies
MN10829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant