Provider Demographics
NPI:1700143153
Name:ABCEJO, ANDREA V (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:V
Last Name:ABCEJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 HIGH POINT DR NE
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-4407
Mailing Address - Country:US
Mailing Address - Phone:507-775-2128
Mailing Address - Fax:
Practice Address - Street 1:846 HIGH POINT DR NE
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920-4407
Practice Address - Country:US
Practice Address - Phone:507-775-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN56761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program