Provider Demographics
NPI:1699199737
Name:ANDREW J WILL MD PA
Entity Type:Organization
Organization Name:ANDREW J WILL MD PA
Other - Org Name:TWIN CITIES PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-841-2345
Mailing Address - Street 1:7235 OHMS LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2148
Mailing Address - Country:US
Mailing Address - Phone:952-841-2345
Mailing Address - Fax:952-841-2346
Practice Address - Street 1:683 BIELENBERG DR STE 103
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1711
Practice Address - Country:US
Practice Address - Phone:952-841-2345
Practice Address - Fax:952-841-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
MN40619261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN369822000Medicaid