Provider Demographics
NPI:1578821997
Name:HOUGHTON, ANDREW STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEVEN
Last Name:HOUGHTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 W 78TH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2570
Mailing Address - Country:US
Mailing Address - Phone:952-946-9777
Mailing Address - Fax:952-946-9888
Practice Address - Street 1:2805 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:763-577-7615
Practice Address - Fax:763-577-7610
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56577207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty