Individual
DR. BLAKE RYAN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 863-4000
(763) 236-3026
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
76399
MN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/16/2021
Last updated
12/17/2025
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