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Contact Information

GLEN P CARLSON, MD
12142 BUSINESS PARK BLVD N
CHAMPLIN, MN55316-4525
 Phone: 952-977-0500
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for GLEN P CARLSON · (Male)

NPI # 1245217231
Status Active
Credentials MD
Entity Individual
Enumeration date 12/29/2005
Last updated 04/04/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • MN License # 44524
  • MN Medicaid 088244500
Hospital affiliation(s)
  • PARK NICOLLET METHODIST HOSPITAL - (Acute Care)
    6500 EXCELSIOR BLVD
    SAINT LOUIS PARK, MN 55426
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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