Minneapolis Plastic Surgery LTD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

788 Issued in MN

Legal business name

MINNEAPOLIS PLASTIC SURGERY LTD

Practice address

4825 Olson Memorial Hwy
#200
Minneapolis, MN 55422

Phone

(763) 545-0443

Fax

(763) 545-2784

NPI assigned

Mar 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard H Tholen, MD

Title

President

Phone

(763) 545-0443

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730156274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4825 OLSON MEMORIAL HWY",
            "address_2": "#200",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55422",
            "telephone_number": "763-545-0443",
            "fax_number": "763-545-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4825 OLSON MEMORIAL HWY",
            "address_2": "#200",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55422",
            "telephone_number": "763-545-0443",
            "fax_number": "763-545-2784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNEAPOLIS PLASTIC SURGERY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THOLEN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-545-0443",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MN",
            "license": "788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA INS CLINIC",
            "identifier": "9813016",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic and Reconstructive Surgery Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Plastic and Reconstructive Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.