Provider Demographics
NPI:1447394424
Name:MINNESOTA ONCOLOGY HEMATOLOGY, PA
Entity type:Organization
Organization Name:MINNESOTA ONCOLOGY HEMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GESME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-884-6300
Mailing Address - Street 1:560 S MAPLE ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387
Mailing Address - Country:US
Mailing Address - Phone:952-442-6006
Mailing Address - Fax:952-442-6004
Practice Address - Street 1:560 S MAPLE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1760
Practice Address - Country:US
Practice Address - Phone:952-442-6006
Practice Address - Fax:952-442-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1076133V00000X, 170300000X, 207R00000X, 207RH0003X, 207RX0202X, 207VX0201X, 2085R0001X, 208G00000X, 363AM0700X, 363AS0400X, 363L00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN896027500Medicaid
MN1145020008Medicare NSC
MN896027500Medicaid