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General NPI Number Information
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NPI Number | 1245646983
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Entity Type | Individual
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Provider Name | ANDREW CHARLES OCKULY DO
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Gender | Male
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 3545 HIGHWAY 61 N
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55110-5223
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Country | US
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Telephone | 651-439-8807
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Fax | 651-439-0232
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Provider Business Mailing Address
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Address Line | 3500 AMERICAN BLVD W STE 300
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City | BLOOMINGTON
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State | MN
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Zip | 55431-4442
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Country | US
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Telephone | 952-512-5600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 71348-21
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 65557
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 71348-21
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 65557
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License Number State | MN
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