Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 26316 | MN |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 26316 | MN |
NPI | 1104885441 |
---|---|
Provider Name | Thomas Lewis Vonsternberg |
First Address | Bloomington, MN 55425-4516 |
Second Address | Minneapolis, MN 55407-3570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A94003 | (02) |