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Blake A Carlson

Radiology

Allopathic & Osteopathic Physicians

3600 Minnesota Dr Ste 800, Edina, MN 55435-7915

PECOS Enrollment

This provider is enrolled in PECOS as BLAKE CARLSON.

Based on the most recent information from CMS, provider Blake A Carlson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1548249956
Provider Type
Individual
Full Name
Carlson, Blake A
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
1/13/2006
Last Updated
1/15/2025

Contact Information

Practice Location

3600 Minnesota Dr Ste 800, Edina, MN 55435-7915

(952) 595-1301

(612) 294-4903

Mailing Location

3600 Minnesota Dr Ste 800, Edina, MN 55435-7915

(952) 595-1301

(612) 294-4903

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License 32592 Minnesota

Provider Identifiers

ID	Description	Issuer
ID 790329400	Description Medicaid	Issuer Unlisted Minnesota

Blake A Carlson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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