Provider Demographics
NPI:1154380830
Name:WIBERG, THOMAS ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDREW
Last Name:WIBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2534
Mailing Address - Country:US
Mailing Address - Phone:651-292-0616
Mailing Address - Fax:651-726-7256
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2534
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:651-726-7256
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN26678207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30427800Medicaid
WI30427800Medicaid