Provider Demographics
NPI:1235429515
Name:ANDERSON, NICHOLAS FREDRICK (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:FREDRICK
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:8170 33RD AVE S MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-523-8500
Mailing Address - Fax:651-523-8584
Practice Address - Street 1:3930 NORTHWOODS DR
Practice Address - Street 2:MAIL STOP 32800A
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-6974
Practice Address - Country:US
Practice Address - Phone:651-523-8500
Practice Address - Fax:651-523-8584
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2015-06-23
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Provider Licenses
StateLicense IDTaxonomies
MN108053207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine