Provider Demographics
NPI:1811163082
Name:MARESH, ANDREW BRUCE (D O)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRUCE
Last Name:MARESH
Suffix:
Gender:M
Credentials:D O
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6401 FRANCE AVE S
Mailing Address - Street 2:FAIRVIEW SOUTHDALE HOSPITAL
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2104
Mailing Address - Country:US
Mailing Address - Phone:952-924-8463
Mailing Address - Fax:952-924-8358
Practice Address - Street 1:6401 FRANCE AVE S
Practice Address - Street 2:FAIRVIEW SOUTHDALE HOSPITAL
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2104
Practice Address - Country:US
Practice Address - Phone:952-924-8463
Practice Address - Fax:952-924-8358
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN51399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine