Provider Demographics
NPI:1114016110
Name:TORKELSON, CAROLYN (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TORKELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:2020 E 28TH ST
Practice Address - Street 2:UFP SMILEY'S CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:612-333-0475
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0560037Medicaid
MN105429OtherUCARE
MN373R4TOOtherBCBS/0D062UO
MN01-07086OtherMEDICA PRIMARY
MN1021402OtherPREFERRED ONE
MN48G82TOOtherBCBS/92541UN
MN01-08098OtherMEDICA CHOICE
MN224519OtherFAIRVIEW
MN768999OtherARAZ
WI34330000Medicaid
MNHP11622OtherHEALTH PARTNERS
MN577931600Medicaid
MN373R4TOOtherBCBS/0D062UO
MN224519OtherFAIRVIEW
MN105429OtherUCARE