Basic Information
| Provider Information | |||||||||
| NPI: | 1992895304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIESA | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1690 UNIVERSITY AVE W | ||||||||
| Address2: | 570 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512324800 | ||||||||
| FaxNumber: | 6512324899 | ||||||||
| Practice Location | |||||||||
| Address1: | 1690 UNIVERSITY AVE W | ||||||||
| Address2: | 570 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512324800 | ||||||||
| FaxNumber: | 6512324899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2006 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36072 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 36072 | 01 | MN | MEDICAL LICENSE | OTHER | 144093400 | 05 | MN | MEDICAID |