Healthcare Provider Details

I. General information

NPI: 1649444167
Provider Name (Legal Business Name): THOMAS ANDREW GEBHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7595 ANAGRAM DR
EDEN PRAIRIE MN
55344-7399
US

IV. Provider business mailing address

7595 ANAGRAM DR
EDEN PRAIRIE MN
55344-7399
US

V. Phone/Fax

Practice location:
  • Phone: 612-573-2200
  • Fax: 612-573-2274
Mailing address:
  • Phone: 612-573-2200
  • Fax: 612-573-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number63594
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: