Healthcare Provider Details

I. General information

NPI: 1093646655
Provider Name (Legal Business Name): MR. ANDREW PAUL HUBARTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 WHITEWATER DR STE 310
MINNETONKA MN
55343-9347
US

IV. Provider business mailing address

4800 EXCELSIOR BLVD APT 420
SAINT LOUIS PARK MN
55416-3061
US

V. Phone/Fax

Practice location:
  • Phone: 866-522-2472
  • Fax: 763-717-8049
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32885
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: