Individual
ANDREW R HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15450 HIGHWAY 7 STE 100, MINNETONKA, MN 55345-3522
(763) 581-8900
Mailing address
12633 SURREY ST, EDEN PRAIRIE, MN 55347-2866
(765) 491-3455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
72806
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000192403
ANTHEM PROVIDER NUMBER
IN
05
—
100097630
—
IN
01
—
10825227
CAQH NUMBER
IN
01
—
9397120
PHCS PID NUMBER
IN
Enumeration date
03/16/2006
Last updated
07/19/2023
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