Provider Demographics
NPI:1770552317
Name:TOONEN, TIMOTHY R (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:TOONEN
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 1:345 SHERMAN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2401
Mailing Address - Country:US
Mailing Address - Phone:651-251-5500
Mailing Address - Fax:651-251-5555
Practice Address - Street 1:345 SHERMAN ST
Practice Address - Street 2:STE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2401
Practice Address - Country:US
Practice Address - Phone:651-251-5500
Practice Address - Fax:651-251-5555
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44618207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01031004OtherPREFERRED ONE
MNHP35326OtherHEALTHPARTNERS
MN141883OtherUCARE MN
WI34196900Medicaid
MN3600236OtherMEDICA
MN325796700Medicaid
MN278S7TOOtherBLUE CROSS BLUE SHIELD MN
MN1629112OtherAMERICA'S PPO
MN3600236OtherMEDICA
MN830008219Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI34196900Medicaid