Individual
THOMAS JERRY IBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7595 ANAGRAM DR, EDEN PRAIRIE, MN 55344-7399
(612) 573-2200
(612) 573-2274
Mailing address
7595 ANAGRAM DR, EDEN PRAIRIE, MN 55344-7399
(612) 573-2200
(612) 573-2274
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
33694
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100494
UCARE
MN
01
—
1025324
PREFERRED ONE
MN
05
—
1272971
—
IA
01
—
22833
AMERICA'S PPO
MN
01
—
253015
MIDLANDS CHOICE INC
MN
01
—
298G3IB
BLUE CROSS
MN
01
—
300032803
RAILROAD MEDICAR WI
MN
01
—
300085351
RAILROAD MEDICARE MN
MN
05
—
34402300
—
WI
01
—
8734132
DAKOTA CARE
MN
05
—
883505500
—
MN
01
—
9F048IB
BLUE CROSS
MN
01
—
HP13581
HEALTHPARTNERS
MN
Enumeration date
05/27/2006
Last updated
07/21/2022
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