MEDICARE: MR. TOMMIE LEE JAMES III PA-C

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	363A00000X	Physician Assistant	13971	MN

General Provider Information

NPI Number	:	1801477013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOMMIE LEE JAMES III PA-C

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4512
Country	:	US
Telephone Number	:	612-775-1800
Fax Number	:

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

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/13/2026

Similar Medicare Providers

1053364513 — THOMAS JOHN CORNELISSEN D.D.S.
Practice Location Address:

3262 W LAKE ST
MINNEAPOLIS, MN
55416-4512

Practice Phone: 612-925-6010
Practice Fax: 612-925-4907

1457374258 — INDY W LANE MD
Practice Location Address:

3270 W LAKE ST
MINNEAPOLIS, MN
55416-4512

Practice Phone: 612-775-1800
Practice Fax:

1114932423 — WALGREEN CO
Practice Location Address:

3240 W LAKE ST
MINNEAPOLIS, MN
55416-4512

Practice Phone: 612-922-8436
Practice Fax:

1821325317 — DR. THOMAS GERALD QUICK MD
Practice Location Address:

3208 W LAKE ST # 113
MINNEAPOLIS, MN
55416-4512

Practice Phone: 612-388-2402
Practice Fax:

1841576808 — MRS. LUCIANA F HALLADAY RPH
Practice Location Address:

3240 W LAKE ST
MINNEAPOLIS, MN
55416-4512

Practice Phone: 612-922-8436
Practice Fax: 612-922-5398

1316215874 — DR. SAMUEL ANNOR ODURO PHARM.D.
Practice Location Address:

3240 W LAKE ST
MINNEAPOLIS, MN
55416-4512

Practice Phone: 651-329-3132
Practice Fax:

Directions to “ MR. TOMMIE LEE JAMES III PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.