Provider Demographics
NPI:1811957012
Name:POKORA, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:POKORA
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 1:4390 MEADOWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6013
Mailing Address - Country:US
Mailing Address - Phone:651-486-3944
Mailing Address - Fax:
Practice Address - Street 1:347 SMITH AVE N
Practice Address - Street 2:SUITE 505
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2387
Practice Address - Country:US
Practice Address - Phone:651-220-6260
Practice Address - Fax:651-220-7777
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI238422080N0001X
MN236262080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6702150Medicaid
WI23842OtherWI LICENSE
WI23842OtherWI LICENSE
MNF68614Medicare UPIN
MNBP0279237OtherDEA #