| Dr Glen P Carlson, MD | |
|
12142 Business Park Blvd N, Champlin, MN 55316-4525 | |
| (952) 977-0500 | |
| Not Available |
| Full Name | Dr Glen P Carlson |
|---|---|
| Gender | Male |
| Speciality | Pediatric Medicine |
| Experience | 27 Years |
| Location | 12142 Business Park Blvd N, Champlin, Minnesota |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245217231 | NPI | - | NPPES |
| 088244500 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 44524 (Minnesota) | Primary |
| 208000000X | Pediatrics | 44524 (Minnesota) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Park Nicollet Methodist Hospital | Saint louis park, MN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Park Nicollet Clinic | 7911819438 | 1611 |
| Entity Name | Park Nicollet Clinic |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780621904 PECOS PAC ID: 7911819438 Enrollment ID: O20031104000046 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Glen P Carlson, MD 8170 33rd Ave S, Po Box 1309 Mail Stop 21110q, Minneapolis, MN 55425-4516 Ph: () - | Dr Glen P Carlson, MD 12142 Business Park Blvd N, Champlin, MN 55316-4525 Ph: (952) 977-0500 |
Carla Schultz, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 11269 Jefferson Hwy N, Champlin, MN 55316 Phone: 763-236-0600 Fax: 763-236-0790 | |
Dr. Lawrence Thomas Mollo, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 12142 Business Park Blvd N, Champlin, MN 55316 Phone: 952-977-0500 | |
Dr. Lea Hilda Ekochin, M.D Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 11269 Jefferson Hwy N, Champlin, MN 55316 Phone: 763-236-0600 |