Individual
CODY D. TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0341
(612) 625-4116
Mailing address
420 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0341
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
13284677-1205
UT
207LP2900X
Pain Medicine (Anesthesiology) Physician
13284677-1205
UT
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
77909
MN
Other
Enumeration date
04/09/2019
Last updated
03/26/2025
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