Individual
TIM THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13208 WALNUT DR, BURNSVILLE, MN 55337-3840
(651) 681-4543
Mailing address
13208 WALNUT DR, BURNSVILLE, MN 55337-3840
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1021
MN
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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