Healthcare Provider Details

I. General information

NPI: 1518931187
Provider Name (Legal Business Name): ORLANDO CHARRY-RODRIQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ORLANDO CHARRY MD

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E 26TH ST STE 503
MINNEAPOLIS MN
55404-4515
US

IV. Provider business mailing address

606 24TH AVE S 606
MINNEAPOLIS MN
55454-1455
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-5100
  • Fax: 612-863-5109
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number43284
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number43284
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: