Carlisle, Jack Victor

Carlisle, Jack Victor is an individual health care provider with primary practice located at 1601 Golf Course Rd , Grand Rapids MN 55744-8648. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Carlisle, Jack Victor can be contacted via phone (218) 326-5000.

Contact Information

Primary practice address
1601 Golf Course Rd Grand Rapids MN 55744-8648
Phone: (218) 326-5000
Fax: (218) 326-1461
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 31750 Minnesota

Profile Details

NPI number 1326023060
LBN Legal business name Carlisle, Jack Victor
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Feb 12th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326023060 NPPES
Minnesota MEDICAID 462700800

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