Healthcare Provider Details

I. General information

NPI: 1275568156
Provider Name (Legal Business Name): DR. CAROL JUNE FARCHMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CAROL JUNE OST

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LONDON RD SUITE 102
DULUTH MN
55812-1788
US

IV. Provider business mailing address

1502 LONDON RD SUITE 102
DULUTH MN
55812-1788
US

V. Phone/Fax

Practice location:
  • Phone: 218-576-0100
  • Fax: 218-576-0126
Mailing address:
  • Phone: 218-727-8228
  • Fax: 218-727-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26944
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: