Provider Demographics
NPI:1134154891
Name:RUPPERT, ANDREW J (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:RUPPERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2800 CAMPUS DRIVE
Mailing Address - Street 2:10
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:763-398-2203
Mailing Address - Fax:763-398-2233
Practice Address - Street 1:3300 OAKDALE AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-398-6611
Practice Address - Fax:763-398-6601
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN496032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I57125Medicare UPIN