Provider Demographics
NPI:1477583086
Name:WINJUM, CHARLES S (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:WINJUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-0506
Mailing Address - Country:US
Mailing Address - Phone:218-435-1212
Mailing Address - Fax:218-435-1302
Practice Address - Street 1:102 SATHER DR
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1531
Practice Address - Country:US
Practice Address - Phone:218-435-1212
Practice Address - Fax:221-843-5130
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN31170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0123282OtherMEDCIA #
MNDA9071015707OtherPREFERRED ONE #
MNMN100018OtherLHS #
MN915965OtherAMERICIA'S PPO/ARAZ #
MN116153OtherUCARE #
MN17708OtherND MEDICAID
MN5T073WIOtherMNBS #
MN12540OtherNDBS #
MNHP20444OtherHEALTHPARNTERS #
MNDA9021015707OtherPREFERRED ONE #
MN0105958OtherMEDICA #
MN054H4WIOtherMNBS #
MN26610OtherNDBS #
MN5T073WIOtherMNBS #