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General NPI Number Information
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NPI Number | 1942260963
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Entity Type | Individual
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Provider Name | THOMAS EVANS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 12000 ELM CREEK BLVD N #140
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7073
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Country | US
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Telephone | 763-420-7048
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Fax | 763-420-7938
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Provider Business Mailing Address
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Address Line | 6613 W SHORE DR
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City | EDINA
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State | MN
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Zip | 55435-1528
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Country | US
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Telephone | 952-920-6600
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Fax | 952-925-5141
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 024280
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License Number State | MN
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