Provider Demographics
NPI:1316059660
Name:MAYO, ANDREW G (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:MAYO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7755 3RD ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5461
Mailing Address - Country:US
Mailing Address - Phone:715-497-6101
Mailing Address - Fax:
Practice Address - Street 1:1065 N 115TH ST STE 120
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4423
Practice Address - Country:US
Practice Address - Phone:402-609-4818
Practice Address - Fax:402-502-4567
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080114800OtherRAILROAD
MN64Q34MAOtherBLUE CROSS MN PRO FEE
MN27G42MAOtherBLUE CROSS MN FACILITY
WI692222800Medicaid
0102524OtherMEDICA
MN1014043Medicaid
NA9031014043OtherPREFERREDONE
HP18067OtherHEALTHPARTNERS