Healthcare Provider Details

I. General information

NPI: 1720057870
Provider Name (Legal Business Name): THOMAS P FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 26TH ST SUITE 100-200
MINNEAPOLIS MN
55404-4526
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 110N
SAINT PAUL MN
55114-2001
US

V. Phone/Fax

Practice location:
  • Phone: 612-884-6300
  • Fax: 612-884-6363
Mailing address:
  • Phone: 651-602-5309
  • Fax: 651-222-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number23520
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: