Healthcare Provider Details

I. General information

NPI: 1235290420
Provider Name (Legal Business Name): ANDREW D. LUNDQUIST DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 OID MINNESOTA AVE MANKATO CLINIC @ DANIEL'S HEALTH CENTER
ST. PETER MN
56082
US

IV. Provider business mailing address

PO BOX 8674 1230 E MAIN ST MANKATO CLINIC LTD
MANKATO MN
56002-8674
US

V. Phone/Fax

Practice location:
  • Phone: 507-934-2325
  • Fax:
Mailing address:
  • Phone: 507-625-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002170
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number786
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: