Healthcare Provider Details

I. General information

NPI: 1629901251
Provider Name (Legal Business Name): SURIYA THOMPSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

13141 HANNOVER CT
APPLE VALLEY MN
55124-9734
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-4477
  • Fax:
Mailing address:
  • Phone: 651-249-8975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: