Provider Demographics
NPI:1578647707
Name:NEVINS, THOMAS E (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:NEVINS
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 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS, MMC 491
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6100
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS , MMC 491
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24349208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1248ONEOtherBCBS-MN
IA1990515Medicaid
MN3100013OtherMEDICA CHOICE
MN60481OtherARAZ
CO91243493Medicaid
OH2116507Medicaid
WI30259400Medicaid
MNMEDICA PRIMARYOtherMEDICA PRIMARY
MN1009256OtherPREFERRED ONE
MN100926OtherUCARE
MT0051731Medicaid
MN2T303NEOtherBCBS-BILLING CODE
MNHP20223OtherHEALTHPARTNERS
OH2116507Medicaid