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General NPI Number Information
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NPI Number | 1417930256
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Entity Type | Individual
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Provider Name | CHARLES MACINTOSH CLIFFE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1026 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-3828
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Country | US
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Telephone | 651-758-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 5785 LAKE AVE
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-2364
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Country | US
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Telephone | 612-940-6512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 36504
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License Number State | MN
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