Provider Demographics
NPI:1487604104
Name:PARTNERS IN PEDIATRICS, LTD.
Entity type:Organization
Organization Name:PARTNERS IN PEDIATRICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-559-2861
Mailing Address - Street 1:12730 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6307
Mailing Address - Country:US
Mailing Address - Phone:763-559-2861
Mailing Address - Fax:763-559-1338
Practice Address - Street 1:12730 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6307
Practice Address - Country:US
Practice Address - Phone:763-559-2861
Practice Address - Fax:763-559-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24942208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN862803300Medicaid
MN862803300Medicaid