Provider Demographics
NPI:1407832900
Name:GRANDE, THOMAS E (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:GRANDE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:METROPOLITAN OBSTETRICS & GYNECOLOGY PA #622
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-227-9141
Mailing Address - Fax:651-265-6772
Practice Address - Street 1:1655 BEAM AVE
Practice Address - Street 2:METROPOLITAN OBSTETRICS & GYNECOLOGY PA #102
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1163
Practice Address - Country:US
Practice Address - Phone:651-227-9141
Practice Address - Fax:651-265-6772
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2017-01-09
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Provider Licenses
StateLicense IDTaxonomies
MN23251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
30476000OtherWISCONSIN MA
960980010508OtherPREICH PROVIDER
102206C280OtherUCARE
A93914OtherCHOICE PLUS
160000060OtherMETRAHEALTH MEDICARE
160011624OtherRR MEDICARE
23250OtherARAZ
0702266OtherSELECT CARE
960980010508OtherPEAK PROVIDER
23182GROtherBCBS
MN633300100Medicaid
92332OtherMEDICA PRIMARY
0010508OtherPREFERRED ONE
0702266OtherMEDICA CHOICE
633300100OtherMINNESOTA MEDICAL ASSISTA
HP13407OtherEMHO
A93914OtherCHOICE PLUS