Provider Demographics
NPI:1386896744
Name:GERMANSON MD PSYCHIATRY LTD
Entity type:Organization
Organization Name:GERMANSON MD PSYCHIATRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:BAUER
Authorized Official - Last Name:GERMANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-956-4057
Mailing Address - Street 1:1161 WAYZATA BLVD E
Mailing Address - Street 2:#228
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1935
Mailing Address - Country:US
Mailing Address - Phone:952-956-4057
Mailing Address - Fax:952-333-8196
Practice Address - Street 1:13911 RIDGEDALE DRIVE
Practice Address - Street 2:SUITE 320
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305
Practice Address - Country:US
Practice Address - Phone:952-956-4057
Practice Address - Fax:952-333-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN432942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN816898900Medicaid
MN279GIGEOtherBCBSMN
MN171122OtherVCARE