Provider Demographics
NPI:1568489540
Name:TYCAST, FRANCIS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:JOHN
Last Name:TYCAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:JOHN
Other - Last Name:TYCAST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19545 W FORD BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9580
Mailing Address - Country:US
Mailing Address - Phone:763-753-3529
Mailing Address - Fax:763-753-9797
Practice Address - Street 1:19545 W FORD BROOK DR
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-9580
Practice Address - Country:US
Practice Address - Phone:763-753-3529
Practice Address - Fax:763-753-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21261207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A94282Medicare UPIN