Healthcare Provider Details

I. General information

NPI: 1194929455
Provider Name (Legal Business Name): DANIEL THOMAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVE
MAPLEWOOD MN
55109-1126
US

IV. Provider business mailing address

2829 UNIVERSITY AVE SE STE 730
MINNEAPOLIS MN
55414-3279
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55174
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number82255-21
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101017181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: