Individual
WALDO B CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1707 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(906) 779-7111
Mailing address
PO BOX 549, IRON MOUNTAIN, MI 49801-0549
(906) 774-1313
(906) 776-5639
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301043955
MI
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
4301043955
MI
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
4301043955
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110088084
RR MEDICARE
MI
05
—
30551400
—
WI
05
—
3228033
—
MI
01
—
3902200121
BCBS MI
MI
Enumeration date
11/23/2005
Last updated
11/17/2022
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