Healthcare Provider Details

I. General information

NPI: 1558657726
Provider Name (Legal Business Name): ANDREW M CLARY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2011
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38500 TANGER DR STE 110
WOODBURY MN
55125-4925
US

IV. Provider business mailing address

38500 TANGER DR STE 110
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 440-821-7325
  • Fax: 651-337-8211
Mailing address:
  • Phone: 440-821-7325
  • Fax: 651-337-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number61695
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: