Provider Demographics
NPI:1851346209
Name:ZWICKEY, TODD ALLEN (M D)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLEN
Last Name:ZWICKEY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4227
Mailing Address - Country:US
Mailing Address - Phone:952-848-8312
Mailing Address - Fax:952-848-8313
Practice Address - Street 1:3100 W 70TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4227
Practice Address - Country:US
Practice Address - Phone:952-848-8312
Practice Address - Fax:952-848-8313
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29959207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN217880000Medicaid
MN180000051Medicare PIN
MNB58488Medicare UPIN