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NPI Code Detail

MEDICARE: DR. CHARLES MACINTOSH CLIFFE M.D.

MEDICARE: DR. CHARLES MACINTOSH CLIFFE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician36504MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417930256
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES MACINTOSH CLIFFE M.D.
Provider Business Mailing Address
First Line : 5785 LAKE AVE
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-2364
Country : US
Telephone Number : 612-940-6512
Fax Number :
Provider Business Practice Location Address
First Line : 1026 7TH ST W
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-3828
Country : US
Telephone Number : 651-758-9500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2005
Last Update Date : 08/21/2025

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