Individual
THADDEUS STANLEY WALCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5775 WAYZATA BLVD, SUITE 200, MINNEAPOLIS, MN 55416-1222
(952) 525-4511
(952) 525-1560
Mailing address
5775 WAYZATA BLVD, SUITE 200, MINNEAPOLIS, MN 55416-1222
(952) 525-4511
(952) 525-1560
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
40359
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01014968
PREFERRED ONE
—
01
—
05-81578
MEDICA
—
05
—
10088
—
ND
01
—
130018102
RAILROAD MEDICARE
—
01
—
31Q17WA
BLUE CROSS BLUE SHIELD
MN
05
—
338516700
—
MN
01
—
41-1677590
1ST CHOICE OF THE MIDWEST
—
01
—
792831
AMERICAS PPO
—
01
—
A011
TRIWEST
—
01
—
HP7170
HEALTHPARTNERS
—
Enumeration date
07/22/2006
Last updated
09/21/2011
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