Healthcare Provider Details

I. General information

NPI: 1629289939
Provider Name (Legal Business Name): ANDREW W GRANDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N STE 440
SAINT PAUL MN
55102-2316
US

IV. Provider business mailing address

420 DELAWARE ST. SE, MMC 96 D429 MAYO MEMORIAL BUILDING
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-6550
  • Fax: 651-241-6586
Mailing address:
  • Phone: 612-624-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number54432
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: