Basic Information
| Provider Information | |||||||||
| NPI: | 1437230836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPARKS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE STREET SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123590475 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 EAST FRANKLIN AVENUE | ||||||||
| Address2: | UFP SMILEY'S CLINIC | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123590475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 45486 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | HP38751 | 01 | MN | HEALTH PARTNERS | OTHER | 01-14574 | 01 | MN | MEDICA CHOICE | OTHER | 01-14574 | 01 | MN | MEDICA PRIMARY | OTHER | 1034262 | 01 | MN | PREFERRED ONE | OTHER | 1906624 | 01 | MN | ARAZ | OTHER | 171764 | 01 | MN | UCARE | OTHER |