Healthcare Provider Details

I. General information

NPI: 1548215767
Provider Name (Legal Business Name): CHARLES O FINNE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CHICAGO AVE S SUITE 300
MINNEAPOLIS MN
55407-1353
US

IV. Provider business mailing address

1055 WESTGATE DR SUITE 190
SAINT PAUL MN
55114-1065
US

V. Phone/Fax

Practice location:
  • Phone: 651-225-7855
  • Fax: 651-225-7878
Mailing address:
  • Phone: 651-312-1500
  • Fax: 651-312-1595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25240
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: