Basic Information
| Provider Information | |||||||||
| NPI: | 1346462702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOURNE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | ELLIOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052177000 | ||||||||
| FaxNumber: | 6052177015 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052177000 | ||||||||
| FaxNumber: | 6052177015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 06/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 125-051911 | IL | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.