1114016110 NPI number — CAROLYN TORKELSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114016110 NPI number — CAROLYN TORKELSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TORKELSON

Provider First Name:

CAROLYN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1114016110

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/01/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

720 WASHINGTON AVE SE

Provider Second Line Business Mailing Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55414-2924

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-884-0649

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2020 E 28TH ST

Provider Second Line Business Practice Location Address:

UFP SMILEY'S CLINIC

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55407

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-333-0770

Provider Business Practice Location Address Fax Number:

612-333-0475

Provider Enumeration Date:

10/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  33653 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0560037 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 105429 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 373R4TO . This is a "BCBS/0D062UO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 01-07086 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1021402 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 48G82TO . This is a "BCBS/92541UN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 01-08098 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 224519 . This is a "FAIRVIEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 768999 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 34330000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: HP11622 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 577931600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".