MEDICARE: DR. ANDREW M CLARY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	61695	MN

General Provider Information

NPI Number	:	1558657726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW M CLARY D.O.

Provider Business Mailing Address
First Line	:	38500 TANGER DR STE 110
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5402
Country	:	US
Telephone Number	:	651-337-8201
Fax Number	:	651-337-8211

Provider Business Practice Location Address
First Line	:	38500 TANGER DR STE 110
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5402
Country	:	US
Telephone Number	:	651-337-8201
Fax Number	:	651-337-8211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2011
Last Update Date	:	01/07/2026

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