MEDICARE: THOMAS WARD WINTER 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
1	207R00000X	Internal Medicine Physician	26621	MN

General Provider Information

NPI Number	:	1629002183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WARD WINTER MD

Provider Business Mailing Address
First Line	:	1884 STOWE AVE
Second Line	:
City	:	ARDEN HILLS
State	:	MN
Zip	:	55112-7810
Country	:	US
Telephone Number	:	651-633-4365
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 SAINT CLAIR AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1137
Country	:	US
Telephone Number	:	651-241-8436
Fax Number	:	651-241-2793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/27/2015

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