Basic Information
| Provider Information | |||||||||
| NPI: | 1720057870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025309 | ||||||||
| FaxNumber: | 6512226786 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 E 26TH ST | ||||||||
| Address2: | SUITE 100-200 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128846300 | ||||||||
| FaxNumber: | 6128846363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 11/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 23520 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0104003 | 01 | MN | PREFERREDONE | OTHER | 30329300 | 05 | WI | MEDICAID | 8T403FL | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 106111 | 01 | MN | UCARE MN | OTHER | 3600776 | 01 | MN | MEDICA | OTHER | 235200100 | 05 | MN | MEDICAID | HP13299 | 01 | MN | HEALTHPARTNERS | OTHER | 1983148 | 05 | IA | MEDICAID | 23324 | 01 | MN | AMERICA'S PPO | OTHER |