Individual
THEODORE MCMENOMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45 10TH ST W, SAINT PAUL, MN 55102
(651) 232-3000
Mailing address
1690 UNIVERSITY AVE W STE 370, SAINT PAUL, MN 55104-3723
(651) 232-6905
(651) 326-8170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2005-0350
NM
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
51402
MN
207RP1001X
Pulmonary Disease Physician
57429
CO
390200000X
Student in an Organized Health Care Education/Training Program
56538-20
WI
Other
Enumeration date
02/06/2007
Last updated
08/01/2018
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