Provider Demographics
NPI:1386810562
Name:WILSON, ANDREW PALMER (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PALMER
Last Name:WILSON
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 1:3366 OAKDALE AVE N STE 605
Mailing Address - Street 2:RESPIRATORY CONSULTANTS, PA
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5700
Mailing Address - Country:US
Mailing Address - Phone:763-520-2940
Mailing Address - Fax:763-520-2943
Practice Address - Street 1:3366 OAKDALE AVE N STE 605
Practice Address - Street 2:RESPIRATORY CONSULTANTS, PA
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5700
Practice Address - Country:US
Practice Address - Phone:763-520-2940
Practice Address - Fax:763-520-2943
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52726207R00000X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN19563OtherRESIDENT PERMIT