Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bradley G Vantatenhove

Individual provider Medical Physician Assistant · NPI 1477360519

Bradley G Vantatenhove is a Physician Assistant in Bloomington, Minnesota. Qualified in 2024, 2 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
2
Licensed in
MN
In the registry since
2024
Specialties on file
3

Practice location Address checks out

8100 Northland Dr
Bloomington, MN 55431-4800
Phone: (952) 831-8742
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9555 Upland Ln N, Maple Grove, MN 55369-4485 — (952) 993-1440

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 15272 (MN)
Medical Physician Assistant Taxonomy 363AM0700X
Surgical Physician Assistant Taxonomy 363AS0400X

Record details

NPI number1477360519
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 12, 2024
Last updated in NPPESFebruary 19, 2025
Certification dateFebruary 19, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Bloomington