Provider Demographics
NPI:1871565499
Name:BAHNSON, BERNE B (MD)
Entity type:Individual
Prefix:
First Name:BERNE
Middle Name:B
Last Name:BAHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-7580
Practice Address - Fax:605-322-7579
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD18772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN072787300Medicaid
ND12242Medicaid
MN142421OtherUCARE
MT46022474340Medicaid
SD57108D002OtherWPS TRICARE
SD370624200OtherDEPT OF LABOR
SD505800OtherARAZ/ AMERICA'S PPO
SD7100643Medicaid
MN92411422904OtherPRIMEWEST
SD1877OtherDAKOTACARE
MN395S8BAOtherCC SYSTEMS/ BLUE PLUS
SD0040300OtherBLUE CROSS
IA1913103Medicaid
SD260050104OtherRR MEDICARE
SD27188OtherSANFORD HEALTH PLAN
SDHP27977OtherHEALTHPARTNERS
SD1592OtherMIDLANDS CHOICE
SD769191019019OtherPREFERRED ONE
SD260050104OtherRR MEDICARE
MT46022474340Medicaid