Provider Demographics
NPI:1124077912
Name:DONOVAN, CHARLES B (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7505 METRO BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3010
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7505 METRO BLVD STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN486032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2443230OtherAMERICA'S PPO
MN505P3DOOtherBLUE CROSS BLUE SHIELD
MNHP63008OtherHEALTHPARTNERS
WI99112184OtherWI HEALTH INSURANCE RISK SHARING PLAN
IA0721050Medicaid
MN16-04146OtherMEDICA
MN252817OtherMIDLANDS CHOICE INC
MN1046956OtherPREFERRED ONE
MN9103415OtherPHCS/MULTIPLAN
MNP00327700OtherRAILROAD MEDICARE MN
MN133042OtherUCARE
WIP00327697OtherRAILROAD MEDICARE WI
WI34864100Medicaid
MN621966700Medicaid
WI005156135Medicare PIN
MNP00327700OtherRAILROAD MEDICARE MN
MN9103415OtherPHCS/MULTIPLAN
MN505P3DOOtherBLUE CROSS BLUE SHIELD
MN1046956OtherPREFERRED ONE
MN252817OtherMIDLANDS CHOICE INC