Provider Demographics
NPI:1902084239
Name:CARLSON, MICHAEL F (CPO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:CARLSON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N SUNRISE AVE STE C8
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2914
Mailing Address - Country:US
Mailing Address - Phone:916-297-7853
Mailing Address - Fax:916-297-7852
Practice Address - Street 1:106 N SUNRISE AVE STE C8
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2914
Practice Address - Country:US
Practice Address - Phone:916-297-7853
Practice Address - Fax:916-297-7852
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist