Provider Demographics
NPI:1326008368
Name:CARLSON, CHAD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:THOMAS
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-221-1102
Mailing Address - Fax:515-221-1272
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-221-1102
Practice Address - Fax:515-221-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA36501204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5705860001Medicare NSC
G62945Medicare UPIN