Active NPI
Charles Joseph Fazio, M.D.
- Emergency Medicine Physician
- Minnetonka, MN
National Provider Identifier
1366694887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 25504
- Practice address
- 401 Carlson Pkwy
Medica Cp433
Minnetonka, MN 55305-5359 - Phone
- (952) 992-3056
- NPI assigned
- Oct 15, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 25504 | MN | Primary |
Addresses
Primary practice location
401 Carlson Pkwy
Medica Cp433
Minnetonka, MN 55305-5359
Mailing address
401 Carlson Pkwy
Medica Cp433
Minnetonka, MN 55305-5359
Phone (952) 992-3056
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25504 | MN | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224028800000",
"number": "1366694887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 CARLSON PKWY",
"address_2": "MEDICA CP433",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553055359",
"telephone_number": "952-992-3056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 CARLSON PKWY",
"address_2": "MEDICA CP433",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553055359",
"telephone_number": "952-992-3056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZIO",
"first_name": "CHARLES",
"middle_name": "JOSEPH",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-15",
"last_updated": "2008-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MN",
"license": "25504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.