MEDICARE: ANDREW H SLATTENGREN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	53992	MN

General Provider Information

NPI Number	:	1578503520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW H SLATTENGREN DO

Provider Business Mailing Address
First Line	:	720 WASHINGTON AVE SE
Second Line	:	UNIVERSITY OF MINNESOTA PHYSICIANS
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2924
Country	:	US
Telephone Number	:	612-884-0649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 BROADWAY AVE
Second Line	:	UMPHYSICIANS BROADWAY FAMILY MEDICINE
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411
Country	:	US
Telephone Number	:	612-302-8200
Fax Number	:	612-302-8275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	02/07/2013

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