Individual
JEREMY TODD CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
Mailing address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
(218) 529-9120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50780
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0130935
MEDICA
—
05
—
614660300
—
MN
01
—
9K492CA
BCBS MN
MN
01
—
P00633143
RAILROAD MEDICARE
—
Enumeration date
08/08/2007
Last updated
02/05/2013
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