Basic Information
| Provider Information | |||||||||
| NPI: | 1316059660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7755 3RD ST N STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551285461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154976101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1065 N 115TH ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681544423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026094818 | ||||||||
| FaxNumber: | 4025024567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38746 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080114800 | 01 | RAILROAD | OTHER | 64Q34MA | 01 | MN | BLUE CROSS MN PRO FEE | OTHER | 27G42MA | 01 | MN | BLUE CROSS MN FACILITY | OTHER | 692222800 | 05 | WI | MEDICAID | 0102524 | 01 | MEDICA | OTHER | 1014043 | 05 | MN | MEDICAID | NA9031014043 | 01 | PREFERREDONE | OTHER | HP18067 | 01 | HEALTHPARTNERS | OTHER |