Provider Demographics
NPI:1528039682
Name:ANDERHOLM, DAVID CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:ANDERHOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 FORTHUN ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-454-0090
Mailing Address - Fax:218-454-0091
Practice Address - Street 1:7115 FORTHUN ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-454-0090
Practice Address - Fax:218-454-0091
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN345432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN503580500Medicaid
MNF37227Medicare UPIN
MN260001298Medicare UPIN