Provider Demographics
NPI:1316940778
Name:THOMSON, VICKI JEAN (MD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:JEAN
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7380 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4535
Mailing Address - Country:US
Mailing Address - Phone:952-927-7337
Mailing Address - Fax:952-927-8610
Practice Address - Street 1:7380 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4535
Practice Address - Country:US
Practice Address - Phone:952-927-7337
Practice Address - Fax:952-927-8610
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN828788100Medicaid
MN828788100Medicaid
F00918Medicare UPIN