Healthcare Provider Details

I. General information

NPI: 1477583086
Provider Name (Legal Business Name): CHARLES S WINJUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SATHER DR
FOSSTON MN
56542-1531
US

IV. Provider business mailing address

PO BOX 506
FOSSTON MN
56542-0506
US

V. Phone/Fax

Practice location:
  • Phone: 218-435-1212
  • Fax: 221-843-5130
Mailing address:
  • Phone: 218-435-1212
  • Fax: 218-435-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31170
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: