Healthcare Provider Details

I. General information

NPI: 1891289732
Provider Name (Legal Business Name): TOMMASO VAGAGGINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 76TH ST STE 300
EDINA MN
55435-6215
US

IV. Provider business mailing address

270 HENNEPIN AVE APT 1624
MINNEAPOLIS MN
55401-7537
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-1131
  • Fax:
Mailing address:
  • Phone: 917-302-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number71837
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: