Organization
NORTHWIND LUNG SPECIALISTS, P.A.
Active
Other names
Northwind Lung Specialists & Sleep Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES O GENSMER M.D. (PRESIDENT)
(763) 746-9463
Entity
Organization
Contact information
Practice address
3758 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2629
(763) 746-9463
Mailing address
3758 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2629
(763) 746-9463
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
26057
MN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
26057
MN
363A00000X
Physician Assistant
Primary
9955
MN
363LA2200X
Adult Health Nurse Practitioner
R-123245-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198292300
MEDICAID
MN
05
—
198292300
—
MN
01
—
C02727
WPS MEDICARE
MN
01
—
CG0937
RAILROAD MEDICARE
MN
Enumeration date
02/08/2007
Last updated
01/21/2011
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