Provider Demographics
NPI:1780612184
Name:CHALGREN, ROBERT DOUGLAS
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:CHALGREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-5109
Mailing Address - Country:US
Mailing Address - Phone:218-263-1000
Mailing Address - Fax:
Practice Address - Street 1:730 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-5109
Practice Address - Country:US
Practice Address - Phone:218-263-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32386100Medicaid
D48460Medicare UPIN