=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366068561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERTO EMILIO FU CARRASCO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2020
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 6TH AVENUE NORTH CENTRACARE RIVER CAMPUS PALLIATIVE CARE
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56303-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-656-7117
-----------------------------------------------------
Fax | 320-255-5810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 6TH AVENUE NORTH CENTRACARE RIVER CAMPUS PALLIATIVE CARE
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56303-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-656-7117
-----------------------------------------------------
Fax | 320-255-5810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 74038
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------