Provider Demographics
NPI:1437230836
Name:SPARKS, CAROLYN DENISE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DENISE
Last Name:SPARKS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-333-0770
Mailing Address - Fax:612-359-0475
Practice Address - Street 1:2615 EAST FRANKLIN AVENUE
Practice Address - Street 2:UFP SMILEY'S CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:612-359-0475
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN45486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP38751OtherHEALTH PARTNERS
MN01-14574OtherMEDICA CHOICE
MN01-14574OtherMEDICA PRIMARY
MN1034262OtherPREFERRED ONE
MN1906624OtherARAZ
MN171764OtherUCARE
H88101Medicare UPIN