Provider Demographics
NPI:1184729337
Name:BACHOWSKI, GARY JAMES (MD, PHD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JAMES
Last Name:BACHOWSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:111 KELLOGG BLVD E
Mailing Address - Street 2:APT. 1712
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1237
Mailing Address - Country:US
Mailing Address - Phone:651-303-1844
Mailing Address - Fax:651-291-3884
Practice Address - Street 1:100 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1411
Practice Address - Country:US
Practice Address - Phone:651-291-6390
Practice Address - Fax:651-291-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN44904207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH77639Medicare UPIN