Provider Demographics
NPI:1992745525
Name:HOROWITZ, CHARLES HAUGEN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HAUGEN
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 HOSPITAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4769
Mailing Address - Country:US
Mailing Address - Phone:763-302-4114
Mailing Address - Fax:763-302-4081
Practice Address - Street 1:9825 HOSPITAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4769
Practice Address - Country:US
Practice Address - Phone:763-302-4114
Practice Address - Fax:763-302-4081
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0265034OtherPREFERRED ONE
MN22786OtherAMERICA'S PPO
MN394788200Medicaid
MN0515203OtherMEDICA
MN14618HOOtherBCBS OF MN
MN100284C029OtherUCARE
IA1964130Medicaid
WI31452100Medicaid
MNHP13549OtherHEALTHPARTNERS
MN130004185OtherRAILROAD MEDICARE
MN100284C029OtherUCARE
MNHP13549OtherHEALTHPARTNERS