Provider Demographics
NPI:1790758118
Name:THOMAS, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:THOMAS
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Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:435 PHALEN BLVD
Mailing Address - Street 2:MAIL STOP 51103H
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-5302
Mailing Address - Country:US
Mailing Address - Phone:651-254-8300
Mailing Address - Fax:651-254-8379
Practice Address - Street 1:435 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 51103H
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-8300
Practice Address - Fax:651-254-8379
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN222662080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN021882100Medicaid
D98243Medicare UPIN
MN021882100Medicaid