Basic Information
| Provider Information | |||||||||
| NPI: | 1578503520 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SLATTENGREN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 WASHINGTON AVE SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554142924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128840649 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 BROADWAY AVE | ||||||||
| Address2: | UMPHYSICIANS BROADWAY FAMILY MEDICINE | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123028200 | ||||||||
| FaxNumber: | 6123028275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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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 | 207Q00000X | 53992 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.