Healthcare Provider Details

I. General information

NPI: 1932693181
Provider Name (Legal Business Name): ANDRE ROBERT THEUERKAUF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVE
MAPLEWOOD MN
55109-1126
US

IV. Provider business mailing address

1110 HIGHLANDS PLAZA DR E STE 220
SAINT LOUIS MO
63110-1351
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7000
  • Fax:
Mailing address:
  • Phone: 314-273-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021028090
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78667
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number78667
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: