Provider Demographics
NPI:1194707828
Name:WINEGARDEN, THOMAS CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CRAIG
Last Name:WINEGARDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7945 STONE CREEK DR
Mailing Address - Street 2:STE 130
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4561
Mailing Address - Country:US
Mailing Address - Phone:952-241-4050
Mailing Address - Fax:952-241-4049
Practice Address - Street 1:7945 STONE CREEK DR
Practice Address - Street 2:STE 130
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4561
Practice Address - Country:US
Practice Address - Phone:952-241-4050
Practice Address - Fax:952-241-4049
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN353222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1518367OtherMEDICA
MNST729WIOtherBCBS OF MN
MN313368100Medicaid
F41840Medicare UPIN
MN260000822Medicare ID - Type Unspecified