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NPI Code Detail

MEDICARE: ERIN WITHERS THACKERAY MD

MEDICARE: ERIN WITHERS THACKERAY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician499874MN
2207RG0100XGastroenterology Physician49874MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P01034526OTHERMNMN MEC RAILROAD

General Provider Information

NPI Number : 1457472268
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN WITHERS THACKERAY MD
Provider Business Mailing Address
First Line : PO BOX 14909
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-0909
Country : US
Telephone Number : 612-871-1145
Fax Number :
Provider Business Practice Location Address
First Line : 9145 SPRINGBROOK DR NW STE 200
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5886
Country : US
Telephone Number : 612-871-1145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 10/22/2024

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Directions to “ ERIN WITHERS THACKERAY MD” Practice Location

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