Carlson, Glen P

Carlson, Glen P is an individual health care provider with primary practice located at 12142 Business Park Blvd N , Champlin MN 55316-4525. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Carlson, Glen P can be contacted via phone (952) 977-0500.

Contact Information

Primary practice address
12142 Business Park Blvd N Champlin MN 55316-4525
Phone: (952) 977-0500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 44524 Minnesota
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 44524 Minnesota

Profile Details

NPI number 1245217231
LBN Legal business name Carlson, Glen P
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 29th, 2005
Last updated Apr 4th, 2016 - about 9 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 1245217231 NPPES
Minnesota MEDICAID 088244500

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