Basic Information
Provider Information | |||||||||
NPI: | 1477650786 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KRENZEL | ||||||||
FirstName: | CHARLES | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
Address2: | 420 DELAWARE STREET SE, MMC 292 | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 55455 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6122736004 | ||||||||
FaxNumber: | 6122738459 | ||||||||
Practice Location | |||||||||
Address1: | 500 HARVARD ST SE | ||||||||
Address2: | UNIT J2-300 | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 554550363 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6122736004 | ||||||||
FaxNumber: | 6122738459 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 24328 | MN | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 1022694 | 01 | MN | PREFERREDONE | OTHER | HP23006 | 01 | MN | HEALTHPARTNERS | OTHER | 105557 | 01 | MN | UCARE | OTHER | 16-02032 | 01 | MN | MEDICA - PRIMARY | OTHER | 20Y61KR | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 16-01939 | 01 | MN | MEDICA - CHOICE | OTHER | 949394 | 01 | MN | ARAZ | OTHER |