Provider Demographics
NPI:1144495722
Name:THORESON, ANDREW ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALLEN
Last Name:THORESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 XENIUM LANE N
Mailing Address - Street 2:SUITE 40
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2668
Mailing Address - Country:US
Mailing Address - Phone:763-398-2203
Mailing Address - Fax:763-398-6533
Practice Address - Street 1:2800 CAMPUS DR STE 20
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2669
Practice Address - Country:US
Practice Address - Phone:763-559-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN487782085R0202X, 2085R0204X
CAA1159172085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology