Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 64923 | MN |
Y | 208600000X | Surgeon | 64923 | MN |
N | 2086S0129X | Vascular Surgeon | D24929 | MD |
NPI | 1013915370 |
---|---|
Provider Name | Dr. Andrew Surmak |
First Address | Downers Grove, IL 60515-1050 |
Second Address | Saint Louis Park, MN 55416-4788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 17/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257281800 | (05) | MD |
339L | (02) | MD |
B66897 | (02) | MD |