Provider Demographics
NPI:1366400772
Name:SHEARER, TERESE MARIE (MD)
Entity type:Individual
Prefix:
First Name:TERESE
Middle Name:MARIE
Last Name:SHEARER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESE
Other - Middle Name:MARIE
Other - Last Name:SANDKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:7373 FRANCE AVE S
Practice Address - Street 2:SUITE 202
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4534
Practice Address - Country:US
Practice Address - Phone:952-428-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN193502000Medicaid
MNE34812Medicare UPIN
MN193502000Medicaid