| Mark S Mellstrom, Md, Pa | |
|
20157 Icenic Trl Lakeville MN 55044-7708 | |
| (952) 469-3393 | |
| (952) 469-3399 |
| Full Name | Mark S Mellstrom, Md, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 20157 Icenic Trl, Lakeville, Minnesota |
| Authorized Official Name and Position | Mark Stanley Mellstrom (PRESIDENT) |
| Authorized Official Contact | 9524693393 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark S Mellstrom, Md, Pa 20157 Icenic Trl Lakeville MN 55044-7708 Ph: (952) 469-3393 | Mark S Mellstrom, Md, Pa 20157 Icenic Trl Lakeville MN 55044-7708 Ph: (952) 469-3393 |
| NPI Number | 1639340409 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 04/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639340409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 27926 (Minnesota) | Primary |
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