Organization
MINNESOTA ONCOLOGY HEMATOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS P. FLYNN M.D. (PRESIDENT)
(612) 863-3961
Entity
Organization
Contact information
Practice address
3960 COON RAPIDS BLVD NW, SUITE 101, COON RAPIDS, MN 55433-2569
(612) 863-8585
Mailing address
2550 UNIVERSITY AVE W, SUITE 110N, SAINT PAUL, MN 55114-1052
(651) 602-5335
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
896027500
—
MN
01
—
8T400MI
BLUE CROSS BLUE SHIELD OF MINNESOTA
MN
Enumeration date
09/10/2008
Last updated
09/10/2008
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