Basic Information
Provider Information
NPI: 1841618154
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESSER
FirstName: THOMAS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14700 28TH AVE N STE 20
Address2:  
City: PLYMOUTH
State: MN
PostalCode: 554474876
CountryCode: US
TelephoneNumber: 7635593779
FaxNumber:  
Practice Location
Address1: 14700 28TH AVE N STE 20
Address2:  
City: PLYMOUTH
State: MN
PostalCode: 55447
CountryCode: US
TelephoneNumber: 7635593779
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/03/2014
LastUpdateDate: 06/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X63477MNY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home