Provider Demographics
NPI:1033108949
Name:BOE, ANDREA M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:BOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:DESFORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:515 22ND AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4652
Mailing Address - Country:US
Mailing Address - Phone:320-759-2640
Mailing Address - Fax:320-759-2023
Practice Address - Street 1:515 22ND AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4652
Practice Address - Country:US
Practice Address - Phone:320-759-2640
Practice Address - Fax:320-759-2023
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1293995OtherARAZ GROUP AMERICAS PPO
HP33010OtherHEALTH PARTNERS
1027349OtherPREFERRED ONE
151840OtherUCARE
068487200OtherMEDICAL ASSISTANCE
MN068787200Medicaid
082R2DEOtherBLUE CROSS BLUE SHIELD
2116695OtherFIRST HEALTH PLAN
0402912OtherMEDICA HEALTH PLANS
1293995OtherARAZ GROUP AMERICAS PPO
H06001Medicare UPIN
MN068787200Medicaid