Provider Demographics
NPI:1215927835
Name:MATH, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:MATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN43423207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
41F23MAOtherBLUE CROSS BLUE SHIELD
04182001OtherMMSI
HP32893OtherHEALTH PARTNERS
098400100OtherMEDICAL ASSISTANCE MA
1027105OtherPREFERRED ONE
110223906OtherRR MEDICARE
151838OtherUCARE
9200084OtherMEDICA HEALTH PLANS
1268923OtherARAZ GROUP AMERICAS PPO
2116692OtherFIRST HEALTH PLAN
440000174Medicare ID - Type Unspecified
110223906OtherRR MEDICARE