Healthcare Provider Details

I. General information

NPI: 1548452733
Provider Name (Legal Business Name): KRISTIE A TOMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 W INTERSTATE AVE
BISMARCK ND
58503-0936
US

IV. Provider business mailing address

401 N 9TH ST
BISMARCK ND
58501-4530
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-3700
  • Fax: 701-323-3710
Mailing address:
  • Phone: 701-530-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11660
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49245
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier15362
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: