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General NPI Number Information
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NPI Number | 1710979489
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Entity Type | Individual
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Provider Name | CHRISTOPHER A. CARLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12000 ELM CREEK BLVD N SUITE 130
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7073
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Country | US
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Telephone | 763-420-5822
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Fax | 763-420-6387
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Provider Business Mailing Address
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Address Line | 9800 ROCKFORD RD SUITE 100
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City | PLYMOUTH
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State | MN
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Zip | 55442-2811
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Country | US
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Telephone | 763-559-0092
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Fax | 763-559-9404
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35353
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License Number State | MN
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