Individual
CHARLES P. NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6405 FRANCE AVE S, SUITE W440, EDINA, MN 55435-2163
(952) 927-7004
(952) 927-5146
Mailing address
6405 FRANCE AVE S, #W440, EDINA, MN 55435-2163
(952) 927-7004
(952) 924-5146
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
31132
MN
2086S0129X
Vascular Surgery Physician
Primary
31132
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335792900
—
MN
01
—
770000441
RAILROAD MEDICARE
MN
Enumeration date
07/06/2006
Last updated
03/08/2017
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