Healthcare Provider Details

I. General information

NPI: 1013915370
Provider Name (Legal Business Name): ANDREW SURMAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 GRAND WAY
SAINT LOUIS PARK MN
55416-4788
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 300
DOWNERS GROVE IL
60515-1050
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-0580
  • Fax:
Mailing address:
  • Phone: 630-725-2730
  • Fax: 844-205-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number64923
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD24929
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: