Individual provider · NPI-1

Amanda Baillargeon, M.D.

Radiology, Diagnostic Radiology · Eden Prairie, MN

NPI number1386063295

StatusActive

Last updated in NPPESJul 12, 2022

Details

NPI: 1386063295
Entity type: Individual (NPI-1)
Name: Amanda Baillargeon
Credential: M.D.
Sex: Female
Sole proprietor: Yes
Enumeration date: Apr 8, 2014
Certification date: Jul 12, 2022
Last updated: Jul 12, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2085R0202X	Radiology, Diagnostic Radiology	59650	MN	Yes
390200000X	Student in an Organized Health Care Education/Training Program	–	–

Practice location

7595 Anagram Dr
Eden Prairie, MN 55344-7399

Phone 612-573-2200 · Fax 612-573-2274

Mailing address

7595 Anagram Dr
Eden Prairie, MN 55344-7399

Phone 612-573-2200 · Fax 612-573-2274

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