Healthcare Provider Details

I. General information

NPI: 1295341048
Provider Name (Legal Business Name): TOBIAS ZANDER DONLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

1708 83RD AVE N
BROOKLYN PARK MN
55444-1552
US

V. Phone/Fax

Practice location:
  • Phone: 763-913-6893
  • Fax:
Mailing address:
  • Phone: 763-913-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number73783
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: