Provider Demographics
NPI:1760442065
Name:HALL, TRICIA JH (DO)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:JH
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:612-676-8992
Practice Address - Street 1:1020 BROADWAY AVE
Practice Address - Street 2:UMPHYSICIANS BROADWAY FAMILY MEDICINE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:612-302-8200
Practice Address - Fax:612-302-8275
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47073207Q00000X
MN44707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP36753OtherHEALTH PARTNERS
MN184577200Medicaid
WI34288800Medicaid
MN0124778OtherMEDICA
MN2444491OtherAMERICA'S PPO
WI34288800Medicaid
MN184577200Medicaid