Basic Information
| Provider Information | |||||||||
| NPI: | 1225299290 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASA | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1027 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565013409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188475611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2008 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 68329 | MN | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | 68329 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 12920 | ND | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 12920 | ND | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 5315036932 | 01 | MI | PHARMACY | OTHER | 4301092629 | 01 | MI | PHYSICIANS EDUCATIONAL LIMITED LICENSE | OTHER | FV4046581 | 01 | ND | ND DEA | OTHER | 12920 | 01 | ND | ND LICENSE | OTHER |