=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144453242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA JAMES THOM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2009
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6401 UNIVERSITY AVE NE
-----------------------------------------------------
City | FRIDLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55432-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-586-5923
-----------------------------------------------------
Fax | 763-392-5604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6401 UNIVERSITY AVE NE
-----------------------------------------------------
City | FRIDLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55432-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-586-5923
-----------------------------------------------------
Fax | 763-392-5604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 85990-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 53216
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------