Provider Demographics
NPI:1134179419
Name:CARLSON, DAVID CONRAD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CONRAD
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10092 PURGATORY RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4745
Mailing Address - Country:US
Mailing Address - Phone:952-944-4070
Mailing Address - Fax:952-944-4070
Practice Address - Street 1:1515 SAINT FRANCIS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3387
Practice Address - Country:US
Practice Address - Phone:952-403-3399
Practice Address - Fax:952-403-3390
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI33472207X00000X
MN26543207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN973505400Medicaid