Healthcare Provider Details

I. General information

NPI: 1386636173
Provider Name (Legal Business Name): TODD W GOTHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/12/2025
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 COUNTY ROAD E W
ARDEN HILLS MN
55112-3783
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-523-8400
  • Fax: 651-484-9650
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33768
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: