Basic Information
| Provider Information | |||||||||
| NPI: | 1730562364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PISANSKY | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7235 OHMS LN | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554392148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528412345 | ||||||||
| FaxNumber: | 9528412346 | ||||||||
| Practice Location | |||||||||
| Address1: | 7270 FORESTVIEW LN N STE 100 | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553695555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528412345 | ||||||||
| FaxNumber: | 9528412346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 272226 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 61043 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 390200000X | 264378 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207LP2900X | 72272 | MN | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.