Provider Demographics
NPI:1699864611
Name:THOMPSON BUUM, HEATHER A (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:THOMPSON BUUM
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 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE STREET SE
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN142411OtherUCARE
MN323088100Medicaid
MN04-04089OtherMEDICA CHOICE
MNHP40590OtherHEALTH PARTNERS
MN170274OtherFAIRVIEW
MN04-00123OtherMEDICA PRIMARY
MN1552594OtherARAZ
MT0051918Medicaid
MN1030018OtherPREFERRED ONE
WI34172900Medicaid
MN04-04089OtherMEDICA CHOICE
110008551Medicare ID - Type Unspecified