Provider Demographics
NPI:1831519602
Name:DIRLAM, CARLY (MD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:
Last Name:DIRLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-273-9824
Mailing Address - Fax:
Practice Address - Street 1:2855 CAMPUS DRIVE
Practice Address - Street 2:ABBOTT NORTHWESTERN - WESTHEALTH, SUITE 660
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441
Practice Address - Country:US
Practice Address - Phone:763-577-7900
Practice Address - Fax:763-577-7905
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN598862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry