Provider Demographics
NPI:1346458213
Name:WU, CHARLIE W (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:W
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1719 TOWER DR W STE 100
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7512
Mailing Address - Country:US
Mailing Address - Phone:651-275-3000
Mailing Address - Fax:651-275-3027
Practice Address - Street 1:237 RADIO DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4478
Practice Address - Country:US
Practice Address - Phone:651-275-3000
Practice Address - Fax:651-275-3027
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN49638207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN49638OtherMEDICAL LICENSE
WI50506OtherWI MEDICAL LICENSE
MNP00419825OtherRAILROAD MEDICARE
MN973445000Medicaid
MNP00419825OtherRAILROAD MEDICARE