Individual
DR. GLEN P CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12142 BUSINESS PARK BLVD N, CHAMPLIN, MN 55316-4525
(952) 977-0500
Mailing address
8170 33RD AVE S, PO BOX 1309 MAIL STOP 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
44524
MN
208000000X
Pediatrics Physician
44524
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088244500
—
MN
Enumeration date
12/29/2005
Last updated
04/04/2016
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