Healthcare Provider Details

I. General information

NPI: 1194707828
Provider Name (Legal Business Name): THOMAS CRAIG WINEGARDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 STONE CREEK DR STE 130
CHANHASSEN MN
55317-4561
US

IV. Provider business mailing address

7945 STONE CREEK DR STE 130
CHANHASSEN MN
55317-4561
US

V. Phone/Fax

Practice location:
  • Phone: 952-241-4050
  • Fax: 952-241-4049
Mailing address:
  • Phone: 952-241-4050
  • Fax: 952-241-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35322
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: