Individual
DR. THEODORE THOMAS JEWETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17705 HUTCHINS DR, MINNETONKA, MN 55345-4145
(952) 401-8300
Mailing address
17705 HUTCHINS DR, MINNETONKA, MN 55345-4145
(952) 401-8300
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21367
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08001JE
BCBS
MN
01
—
100452
UCARE
MN
01
—
1210207
MEDICA
MN
01
—
CP9040844007
PREFERRED ONE
MN
Enumeration date
02/06/2006
Last updated
07/09/2007
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