Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 37403 | MN |
N | 2086S0120X | Pediatric Surgery | 37403 | MN |
NPI | 1013953371 |
---|---|
Provider Name | Mr. Richard G Karlen |
First Address | Woodbury, MN 55125 |
Second Address | Woodbury, MN 55125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 31/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
998520400 | (05) | MN |
F82242 | (02) |