Organization
CHARLES R NICOLOSI M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES R NICOLOSI MD (OWNER)
(608) 788-8103
Entity
Organization
Contact information
Practice address
2031 32ND ST S, LA CROSSE, WI 54601-7099
(608) 788-8103
Mailing address
1116 MILL ST W, CANNON FALLS, MN 55009-1824
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20585
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127T7NI
BCBS
MN
Enumeration date
01/03/2008
Last updated
01/03/2008
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