Provider Demographics
NPI:1881681815
Name:PORTIS, ANDREW JOHN (MD)
Entity Type:Individual
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First Name:ANDREW
Middle Name:JOHN
Last Name:PORTIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 240N
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-999-6909
Mailing Address - Fax:651-297-6115
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6810
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN42720208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH03663Medicare UPIN