Healthcare Provider Details

I. General information

NPI: 1710299706
Provider Name (Legal Business Name): ALONSO CARRASCO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE STE 550
MINNEAPOLIS MN
55404-4293
US

IV. Provider business mailing address

4530 77TH ST W STE 205
EDINA MN
55435-5003
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-8000
  • Fax: 612-813-8005
Mailing address:
  • Phone: 612-813-8000
  • Fax: 952-835-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number04-39904
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number54064
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number2017002201
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberV8469
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberDR.0055046
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: