Healthcare Provider Details

I. General information

NPI: 1043256357
Provider Name (Legal Business Name): CHRISTOPHER JOHN TOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 RADIO DR
WOODBURY MN
55125-5805
US

IV. Provider business mailing address

215 RADIO DR STE 202
WOODBURY MN
55125-5822
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-0750
  • Fax: 651-645-6166
Mailing address:
  • Phone: 651-702-0750
  • Fax: 651-645-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36117
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number40701-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number40701-20
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number36117
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: