Provider Demographics
NPI:1710299706
Name:CARRASCO, ALONSO JR (MD)
Entity type:Individual
Prefix:
First Name:ALONSO
Middle Name:
Last Name:CARRASCO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 77TH ST W STE 205
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5003
Mailing Address - Country:US
Mailing Address - Phone:612-813-8000
Mailing Address - Fax:952-835-9443
Practice Address - Street 1:2530 CHICAGO AVE STE 550
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4293
Practice Address - Country:US
Practice Address - Phone:612-813-8000
Practice Address - Fax:612-813-8005
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-399042088P0231X
MN540642088P0231X
MO20170022012088P0231X
TXV84692088P0231X
CODR.00550462088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIENROLLEDMedicaid
MNP01021777OtherRAIL ROAD - MEDICARE
MNENROLLEDMedicaid
WIENROLLEDMedicaid