Provider Demographics
NPI:1710979489
Name:CARLSON, CHRISTOPHER A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9800 ROCKFORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2811
Mailing Address - Country:US
Mailing Address - Phone:763-559-0092
Mailing Address - Fax:763-559-9404
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 130
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-420-5822
Practice Address - Fax:763-420-6387
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN35353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF68416Medicare UPIN