Provider Demographics
NPI:1811104433
Name:TOM, CINDY W (MD)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:W
Last Name:TOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 500 E
Mailing Address - Street 2:STE 320
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2462
Mailing Address - Country:US
Mailing Address - Phone:406-237-5001
Mailing Address - Fax:406-237-5010
Practice Address - Street 1:2900 12TH AVE N STE 204E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7502
Practice Address - Country:US
Practice Address - Phone:406-237-5001
Practice Address - Fax:406-237-5010
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN46128207R00000X
UT9698871-1205207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46128OtherMN LICENSE
H94864Medicare UPIN
MN46128OtherMN LICENSE