Provider Demographics
NPI:1578807491
Name:ANDROS ENT & SLEEP CENTER PA
Entity Type:Organization
Organization Name:ANDROS ENT & SLEEP CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-888-7800
Mailing Address - Street 1:5565 BLAINE AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1239
Mailing Address - Country:US
Mailing Address - Phone:651-888-7800
Mailing Address - Fax:651-888-7801
Practice Address - Street 1:5565 BLAINE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1207
Practice Address - Country:US
Practice Address - Phone:651-888-7800
Practice Address - Fax:651-888-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X
MN39684207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty