Healthcare Provider Details

I. General information

NPI: 1407832900
Provider Name (Legal Business Name): THOMAS E GRANDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BEAM AVE METROPOLITAN OBSTETRICS & GYNECOLOGY PA #102
MAPLEWOOD MN
55109-1163
US

IV. Provider business mailing address

17 EXCHANGE ST W METROPOLITAN OBSTETRICS & GYNECOLOGY PA #622
SAINT PAUL MN
55102-1045
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-9141
  • Fax: 651-265-6772
Mailing address:
  • Phone: 651-227-9141
  • Fax: 651-265-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number23251
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: