Provider Demographics
NPI:1053357004
Name:ANDRISEVIC, JAMES H (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:ANDRISEVIC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:303 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4522
Mailing Address - Country:US
Mailing Address - Phone:952-435-4140
Mailing Address - Fax:952-435-4189
Practice Address - Street 1:4570 W 77TH ST
Practice Address - Street 2:SUITE 235
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5008
Practice Address - Country:US
Practice Address - Phone:952-832-0805
Practice Address - Fax:952-832-5597
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MN23231208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN23231OtherMN LICENSE
MNHP12805OtherHEALTHPARTNERS
MN1727004OtherMEDICA
MN25107OtherAMERICA'S PPO
MN138J7ANOtherBLUECROSS/BLUE SHIELD MN
MN112126OtherUCARE MN
FM961901000016OtherPREFERREDONE
FM961901000016OtherPREFERREDONE
FM961901000016OtherPREFERREDONE