Provider Demographics
NPI:1780684126
Name:SIMONSON, TEREASA M (MD)
Entity Type:Individual
Prefix:
First Name:TEREASA
Middle Name:M
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEREASA
Other - Middle Name:M
Other - Last Name:KAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7366
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-7366
Mailing Address - Country:US
Mailing Address - Phone:320-255-5619
Mailing Address - Fax:320-656-7068
Practice Address - Street 1:1406 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1900
Practice Address - Country:US
Practice Address - Phone:320-255-5619
Practice Address - Fax:320-656-7068
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN383342085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16-00698OtherMEDICA
MN26649OtherARAZ/ AMERICA'S PPO
MN411772562OtherTRICARE
MN30005364OtherRAILROAD MEDICARE
MN411772562OtherGREATWEST HEALTHCARE
MN6D568SIOtherBLUE CROSS BLUE SHIELD
MN965251008760OtherPREFERRED ONE
MN895819000Medicaid
MNHP25520OtherHEALTH PARTNERS
MN111039C561OtherUCARE OF MINNESOTA
MN6D568SIOtherBLUE CROSS BLUE SHIELD
MN895819000Medicaid
CABH246YMedicare PIN
CABH252UMedicare PIN
CABH252XMedicare PIN
MNHP25520OtherHEALTH PARTNERS
MN309000578Medicare ID - Type Unspecified
CABH252RMedicare PIN
CABH252VMedicare PIN
CABH246WMedicare PIN
CABH252QMedicare PIN
CABH252YMedicare PIN
MN16-00698OtherMEDICA
CABH252TMedicare PIN