Provider Demographics
NPI:1417930256
Name:CLIFFE, CHARLES MACINTOSH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MACINTOSH
Last Name:CLIFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2534
Mailing Address - Country:US
Mailing Address - Phone:651-292-0616
Mailing Address - Fax:651-726-7256
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2534
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:651-726-7256
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN36504207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31998000Medicaid
MNF62914Medicare UPIN