Provider Demographics
NPI:1275568156
Name:FARCHMIN, CAROL JUNE
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JUNE
Last Name:FARCHMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:JUNE
Other - Last Name:OST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1502 LONDON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1788
Mailing Address - Country:US
Mailing Address - Phone:218-727-8228
Mailing Address - Fax:218-727-7771
Practice Address - Street 1:1502 LONDON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1788
Practice Address - Country:US
Practice Address - Phone:218-576-0100
Practice Address - Fax:218-576-0126
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275568156Medicaid
WI1275568156Medicaid
MN506063000Medicaid
MN080117798OtherRAILROAD MEDICARE
MN080117798OtherRAILROAD MEDICARE
MND48550Medicare UPIN
MI1275568156Medicaid