Provider Demographics
NPI:1063489540
Name:POGEMILLER, CHARLES E SR (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:POGEMILLER
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1215 TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1033
Mailing Address - Country:US
Mailing Address - Phone:651-326-1515
Mailing Address - Fax:651-326-1519
Practice Address - Street 1:1215 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1033
Practice Address - Country:US
Practice Address - Phone:651-326-1515
Practice Address - Fax:651-326-1519
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-06-26
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Provider Licenses
StateLicense IDTaxonomies
MNMN22425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN737885800Medicaid
MN737885800Medicaid
D48889Medicare UPIN