MEDICARE: DR. ANDREW ALLEN THORESON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	48778	MN
2	2085R0204X	Vascular & Interventional Radiology Physician	A115917	CA
3	2085R0204X	Vascular & Interventional Radiology Physician	48778	MN

General Provider Information

NPI Number	:	1144495722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW ALLEN THORESON MD

Provider Business Mailing Address
First Line	:	2955 XENIUM LANE N
Second Line	:	SUITE 40
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-2668
Country	:	US
Telephone Number	:	763-398-2203
Fax Number	:	763-398-6533

Provider Business Practice Location Address
First Line	:	2800 CAMPUS DR STE 20
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-2669
Country	:	US
Telephone Number	:	763-559-2171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	11/20/2023

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