Provider Demographics
NPI:1154524056
Name:THOMAS D DRESSEL MD PA
Entity type:Organization
Organization Name:THOMAS D DRESSEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DRESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-929-1812
Mailing Address - Street 1:7801 E. BUSH LAKE ROAD
Mailing Address - Street 2:SUITE #320
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:952-831-5773
Mailing Address - Fax:952-831-7224
Practice Address - Street 1:6545 FRANCE AVE SO.
Practice Address - Street 2:SUITE 301
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-929-1812
Practice Address - Fax:952-929-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN158372700Medicaid
MNC36278Medicare UPIN
MN240000023Medicare ID - Type Unspecified