Provider Demographics
NPI:1215171335
Name:BARRETT, TODD ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANDREW
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:327 CENTRAL AVE SE
Mailing Address - Street 2:NORTH MEMORIAL - NORTHEAST FAMILY PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1019
Mailing Address - Country:US
Mailing Address - Phone:612-379-1119
Mailing Address - Fax:612-379-4936
Practice Address - Street 1:327 CENTRAL AVE SE
Practice Address - Street 2:NORTH MEMORIAL - NORTHEAST FAMILY PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1019
Practice Address - Country:US
Practice Address - Phone:612-379-1119
Practice Address - Fax:612-379-4936
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MN52930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program