MEDICARE: DR. CHARLES RICHARD JORGENSEN 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
1	207RC0000X	Cardiovascular Disease Physician	16540	MN

General Provider Information

NPI Number	:	1588729297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES RICHARD JORGENSEN M.D.

Provider Business Mailing Address
First Line	:	1615 E RIVER PKWY
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-3627
Country	:	US
Telephone Number	:	612-332-1140
Fax Number	:	612-672-9596

Provider Business Practice Location Address
First Line	:	1615 E RIVER PKWY
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-3627
Country	:	US
Telephone Number	:	612-332-1140
Fax Number	:	612-672-9596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	12/28/2025

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