Individual
DR. THOMAS MICHAEL MISUKANIS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
7800 METRO PKWY, SUITE 300, BLOOMINGTON, MN 55425-1514
(952) 876-0727
(952) 851-9618
Mailing address
7800 METRO PKWY, SUITE 300, BLOOMINGTON, MN 55425-1514
(952) 876-0727
(952) 851-9618
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1929
CO
103G00000X
Clinical Neuropsychologist
Primary
LP3921
MN
103TC0700X
Clinical Psychologist
1929
CO
103TC0700X
Clinical Psychologist
LP3921
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
460980800
—
MN
Enumeration date
12/08/2006
Last updated
12/30/2020
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