Provider Demographics
NPI:1871566331
Name:GRATZER, THOMAS G (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:GRATZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-645-3115
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 229N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1902
Practice Address - Country:US
Practice Address - Phone:651-645-3115
Practice Address - Fax:651-645-2752
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN379822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260002413Medicare PIN