Doctor Name: | THRESIAMMA AUGUSTINE JOSEPH |
NPI Number: | 1144214107 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 32036 |
Business Practice Address: | 3585 Lexington Ave N Ste 350 Shoreview, MN - 551268064 |
Business Phone Number: | 6514843942 |
Business Fax Number: | 6517870519 |
Mailing Address: | 3585 Lexington Ave N, Ste 350 SHOREVIEW |
State: | MN |
Postal Code: | 551268064 |
Phone Number: | 6512515280 |
Fax Number: | 6512515282 |
NPI Enumeration Date: | 09/07/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2080A0000X |
License Number: | 32036 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Pediatrics |
Taxonomy Specialization: | Adolescent Medicine |
Taxonomy Definition: | A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |