Individual
THOMAS BRADLEY CARIVEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
929 CENTRAL AVE NW, EAST GRAND FORKS, MN 56721-1917
(218) 773-6800
(218) 773-6861
Mailing address
1298 BURBANK, GRAND FORKS, ND 58201-3712
(701) 772-7758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28494
MN
207Q00000X
Family Medicine Physician
5343
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123578
MEDICA
—
05
—
044782000
—
MN
01
—
080161924
MEDICARE RAILROAD
MN
05
—
15307
—
ND
01
—
26521
BCBS
ND
01
—
512M2CA
BCBS
MN
01
—
NA4571023344
PREFERRED ONE
—
Enumeration date
05/28/2006
Last updated
06/11/2008
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