Individual
THOMAS PAUL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11725 STINSON AVE, CHISAGO CITY, MN 55013-9542
(651) 257-8499
Mailing address
490 OWASSO HILLS DR, ROSEVILLE, MN 55113-2153
(612) 759-3476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
49732
MN
207QS1201X
Sleep Medicine (Family Medicine) Physician
Primary
49732
MN
Other
Enumeration date
04/13/2007
Last updated
03/11/2012
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