Provider Demographics
NPI:1942260963
Name:EVANS, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1528
Mailing Address - Country:US
Mailing Address - Phone:952-920-6600
Mailing Address - Fax:952-925-5141
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:#140
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-420-7048
Practice Address - Fax:763-420-7938
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN024280207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN66800006OtherMEDICA PREMIER
MN6611066OtherMEDICA CHOICE
MN1004619OtherPREFERRED ONE
MN119979OtherKVI/PATIENT CHOICE
MN799306500Medicaid
MNHP13249OtherHEALTHPARTNERS
MN125487OtherUCARE
MN8T308EVOtherBLUE CROSS BLUE SHIELD
MN8T308EVOtherBLUE CROSS BLUE SHIELD
MN799306500Medicaid
MN125487OtherUCARE