Provider Demographics
NPI:1629396619
Name:MAUST, THOMAS JENNINGS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JENNINGS
Last Name:MAUST
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:PO BOX 9104
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55480-9104
Mailing Address - Country:US
Mailing Address - Phone:952-993-3246
Mailing Address - Fax:952-993-3010
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:PARK NICOLLET CLINIC
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-993-3246
Practice Address - Fax:952-993-3010
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program