1407832900 NPI number — THOMAS E GRANDE MD

Table of content: THOMAS E GRANDE MD (NPI 1407832900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407832900 NPI number — THOMAS E GRANDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANDE
Provider First Name:
THOMAS
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407832900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 EXCHANGE ST W
Provider Second Line Business Mailing Address:
METROPOLITAN OBSTETRICS & GYNECOLOGY PA #622
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102-1045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-227-9141
Provider Business Mailing Address Fax Number:
651-265-6772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1655 BEAM AVE
Provider Second Line Business Practice Location Address:
METROPOLITAN OBSTETRICS & GYNECOLOGY PA #102
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-227-9141
Provider Business Practice Location Address Fax Number:
651-265-6772
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  23251 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30476000 . This is a "WISCONSIN MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 960980010508 . This is a "PREICH PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102206C280 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A93914 . This is a "CHOICE PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160000060 . This is a "METRAHEALTH MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160011624 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23250 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0702266 . This is a "SELECT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 960980010508 . This is a "PEAK PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23182GR . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 633300100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92332 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010508 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0702266 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 633300100 . This is a "MINNESOTA MEDICAL ASSISTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP13407 . This is a "EMHO" identifier . This identifiers is of the category "OTHER".




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