MEDICARE: EMILY TONKIN, LLC

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
1	2084P0800X	Psychiatry Physician
2	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1588277677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY TONKIN, LLC

Provider Business Mailing Address
First Line	:	4718 XERXES AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-3732
Country	:	US
Telephone Number	:	952-217-6750
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL STE 1246
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2702
Country	:	US
Telephone Number	:	612-254-2527
Fax Number	:	612-354-4537

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMILY TONKIN
Credential	:	DO
Telephone Number	:	612-254-2527

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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