Provider Demographics
NPI:1922047604
Name:SUTTON, THOMAS MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:SUTTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2530 CHICAGO AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4291
Mailing Address - Country:US
Mailing Address - Phone:612-813-8800
Mailing Address - Fax:612-813-8825
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:STE 500
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4291
Practice Address - Country:US
Practice Address - Phone:612-813-8800
Practice Address - Fax:612-813-8825
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN241232080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30391000Medicaid
MN616387400Medicaid
MND83767Medicare UPIN
MN616387400Medicaid