Healthcare Provider Details

I. General information

NPI: 1801092119
Provider Name (Legal Business Name): TARA DOYLE TREDENNICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MINNESOTA DR STE 800
EDINA MN
55435-7915
US

IV. Provider business mailing address

3600 MINNESOTA DR STE 800
EDINA MN
55435-7915
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax:
Mailing address:
  • Phone: 952-595-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0054036
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number45747
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT190102
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: