Basic Information
| Provider Information | |||||||||
| NPI: | 1497805071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANDELIN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | PO BOX 8674 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1900 SUNRISE DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAINT PETER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560825376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073898538 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 50184-21 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | 60390 | MN | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 50184-21 | WI | N | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.