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General NPI Number Information
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NPI Number | 1700857018
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Entity Type | Individual
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Provider Name | THOMAS MICHAEL KING MD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 15290 PENNOCK LN
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7163
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Country | US
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Telephone | 952-431-8500
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Fax | 952-431-6966
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Provider Business Mailing Address
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Address Line | 8100 34TH AVE S MS 2111OQ
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1672
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Country | US
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Telephone | 952-431-8500
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Fax | 952-431-6966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29075
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License Number State | MN
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