Healthcare Provider Details

I. General information

NPI: 1033108949
Provider Name (Legal Business Name): ANDREA M BOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA M DESFORGE MD

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

IV. Provider business mailing address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

V. Phone/Fax

Practice location:
  • Phone: 320-759-2640
  • Fax: 320-759-2023
Mailing address:
  • Phone: 320-763-2540
  • Fax: 320-763-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43901
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: