Provider Demographics
NPI:1730156274
Name:MINNEAPOLIS PLASTIC SURGERY LTD
Entity type:Organization
Organization Name:MINNEAPOLIS PLASTIC SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:THOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-545-0443
Mailing Address - Street 1:4825 OLSON MEMORIAL HWY
Mailing Address - Street 2:#200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-545-0443
Mailing Address - Fax:763-545-2784
Practice Address - Street 1:4825 OLSON MEMORIAL HWY
Practice Address - Street 2:#200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-545-0443
Practice Address - Fax:763-545-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7882086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9813016OtherMEDICA INS CLINIC