Provider Demographics
NPI:1710484837
Name:THIMESCH, NICK ALEXANDER
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:ALEXANDER
Last Name:THIMESCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4379
Mailing Address - Country:US
Mailing Address - Phone:763-581-5500
Mailing Address - Fax:763-581-5501
Practice Address - Street 1:2600 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55421-4379
Practice Address - Country:US
Practice Address - Phone:763-581-5500
Practice Address - Fax:763-581-5501
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine