Individual
CHARLES R NICOLOSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
116 MILL ST W., CANNON FALLS, MN 55009-2027
(608) 788-8103
Mailing address
2031 32ND ST S, LA CROSSE, WI 54601-7099
(608) 788-8103
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20585
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127T7NI
BCBS MN
MN
Enumeration date
10/25/2006
Last updated
11/14/2007
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