Provider Demographics
NPI:1528185758
Name:CRIMMINS, TIMOTHY JESSE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JESSE
Last Name:CRIMMINS
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 1:1 GENERAL MILLS BLVD
Mailing Address - Street 2:NO2A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1347
Mailing Address - Country:US
Mailing Address - Phone:763-764-3952
Mailing Address - Fax:
Practice Address - Street 1:1 GENERAL MILLS BLVD
Practice Address - Street 2:NO2A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-1347
Practice Address - Country:US
Practice Address - Phone:763-764-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27766207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95575Medicare UPIN