Provider Demographics
NPI:1336179910
Name:BASS, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:1720 HIGHWAY 59 S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4331
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43101207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN73Q72BAOtherMNBS #
MN0701567OtherMEDICA #
MNND200210OtherLHS #
MNHP38654OtherHEALTHPARTNERS #
MN141993OtherUCARE #
MN1172372OtherAMERICA'S PPO/ARAZ #
MN12150Medicaid
MN20477OtherNDBS #
MN5041522000Medicaid
MNDA9021026958OtherPREFERRED ONE #
MNDA9021026958OtherPREFERRED ONE #
MN73Q72BAOtherMNBS #
MNHP38654OtherHEALTHPARTNERS #
MNND200210OtherLHS #