Basic Information
| Provider Information | |||||||||
| NPI: | 1558773788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICKINSON | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MARTIN LUTHER KING DR | ||||||||
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| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560016460 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1217 8TH ST N | ||||||||
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| City: | NEW ULM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560731552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072175000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2014 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 59680 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.