Provider Demographics
NPI:1912993049
Name:GEORGE, CAROLINE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:LEE SISOLA
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:612-676-8992
Practice Address - Street 1:2450 RIVERSIDE AVE S0
Practice Address - Street 2:CENTER FOR PEDIATRIC BLOOD AND MARROW TRANSPLATION
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1400
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA324742080P0203X
MN497262080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45387OtherWELLMARK BCBS
IA0174292Medicaid
G31906Medicare UPIN
IA0174292Medicaid