Provider Demographics
NPI:1558487041
Name:THAO, XOUA (MD)
Entity Type:Individual
Prefix:DR
First Name:XOUA
Middle Name:
Last Name:THAO
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 1:1026 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3828
Mailing Address - Country:US
Mailing Address - Phone:651-241-1133
Mailing Address - Fax:
Practice Address - Street 1:312 W LAKE ST STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4899
Practice Address - Country:US
Practice Address - Phone:612-354-7930
Practice Address - Fax:612-345-5826
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN655218800Medicaid
MN7D714THOtherBLUE CROSS BLUE SHIELD
MN0102412OtherMEDICA
MN109414OtherUCARE MINNESOTA
MN080003701Medicare ID - Type Unspecified
MN655218800Medicaid