Individual
ERIN WITHERS THACKERAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9145 SPRINGBROOK DR NW STE 200, COON RAPIDS, MN 55433-5886
(612) 871-1145
Mailing address
PO BOX 14909, MINNEAPOLIS, MN 55414-0909
(612) 871-1145
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
49874
MN
207RG0100X
Gastroenterology Physician
499874
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252403000
—
MN
01
—
P01034526
MN MEC RAILROAD
MN
Enumeration date
04/02/2007
Last updated
10/22/2024
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