Provider Demographics
NPI:1093954422
Name:BLEGEN, CARL (M D)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:BLEGEN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 50TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8110
Mailing Address - Country:US
Mailing Address - Phone:612-839-9252
Mailing Address - Fax:763-972-9059
Practice Address - Street 1:5035 50TH ST SE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8110
Practice Address - Country:US
Practice Address - Phone:612-839-9252
Practice Address - Fax:763-972-9059
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22333207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine