Basic Information
| Provider Information | |||||||||
| NPI: | 1003991449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCBROOM | ||||||||
| FirstName: | SAUL | ||||||||
| MiddleName: | AARRON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5 W LAKE ST | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554083117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125459250 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21260 CHIPPENDALE AVE W | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550241427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514637181 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 47721 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1032683 | 01 | PREFERRED ONE | OTHER | 34680300 | 05 | WI | MEDICAID | 660303300 | 05 | MN | MEDICAID | HP54877 | 01 | HEALTHPARTNERS | OTHER | 0596171 | 05 | IA | MEDICAID | 106789 | 01 | UCARE | OTHER | 634T2SA | 01 | BLUE CROSS BLUE SHIELD | OTHER | 66-08732 | 01 | MEDICA/URGENT CARE | OTHER |