MEDICARE: ANDROS ENT & SLEEP CENTER PA

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	207Y00000X	Otolaryngology Physician
2	207YS0012X	Sleep Medicine (Otolaryngology) Physician	39684	MN

General Provider Information

NPI Number	:	1578807491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDROS ENT & SLEEP CENTER PA

Provider Business Mailing Address
First Line	:	5565 BLAINE AVE STE 225
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1239
Country	:	US
Telephone Number	:	651-888-7800
Fax Number	:	651-888-7801

Provider Business Practice Location Address
First Line	:	5565 BLAINE AVE
Second Line	:	SUITE 225
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1207
Country	:	US
Telephone Number	:	651-888-7800
Fax Number	:	651-888-7899

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	INELL C ROSARIO
Credential	:	M.D
Telephone Number	:	651-888-7800

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	02/17/2023

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