Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D10904 | MN |
NPI | 1912970062 |
---|---|
Provider Name | Dr. Karl Haakon Andreasen |
First Address | Roseville, MN 55113-6154 |
Second Address | Roseville, MN 55113-6154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1497814032 | CLINIC NPI (01) | MN |
U77415 | (02) | MN |