Provider Demographics
NPI:1659597714
Name:BAKKE, ANDREW LARS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LARS
Last Name:BAKKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 BROADWAY N
Mailing Address - Street 2:PO BOX MC
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122
Mailing Address - Country:US
Mailing Address - Phone:701-234-5121
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:PO BOX MC
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58122
Practice Address - Country:US
Practice Address - Phone:701-234-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11567207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine