Provider Demographics
NPI:1417978289
Name:DAVIN, THOMAS DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DENNIS
Last Name:DAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2128
Mailing Address - Country:US
Mailing Address - Phone:763-561-5349
Mailing Address - Fax:
Practice Address - Street 1:6601 LYNDALE AVE S
Practice Address - Street 2:STE 220
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2477
Practice Address - Country:US
Practice Address - Phone:612-823-8001
Practice Address - Fax:612-823-1010
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22137207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN28612DAOtherBLUE CROSS BLUE SHIELD MN
MN3115014OtherMEDICA
MNHP13141OtherHEALTHPARTNERS
MN100267C028OtherUCARE
WI30213100Medicaid
MN33003OtherPREFERRED ONE
MNIM3701OtherAMERICA'S PPO
MN114002700Medicaid
MN390001622Medicare PIN
MNIM3701OtherAMERICA'S PPO
MN28612DAOtherBLUE CROSS BLUE SHIELD MN