Provider Demographics
NPI:1649285495
Name:STRAUGHAN, CAROL J (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:STRAUGHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2353 RICE ST
Mailing Address - Street 2:#209
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3739
Mailing Address - Country:US
Mailing Address - Phone:612-616-6040
Mailing Address - Fax:
Practice Address - Street 1:1805 HENNEPIN AVE N
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1416
Practice Address - Country:US
Practice Address - Phone:320-864-3121
Practice Address - Fax:320-864-7887
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH08190Medicare UPIN