MEDICARE: DR. GARY R CARLSON MD

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	207Q00000X	Family Medicine Physician	30898	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1770545709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY R CARLSON MD

Provider Business Mailing Address
First Line	:	3433 BROADWAY ST NE
Second Line	:	STE 300
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1761
Country	:	US
Telephone Number	:	763-587-7737
Fax Number	:	763-587-7069

Provider Business Practice Location Address
First Line	:	2833 CHICAGO AVE. SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3799
Country	:	US
Telephone Number	:	612-863-3333
Fax Number	:

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	02/18/2020

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