| Stillwater Medical Group Mahtomedi | |
|
700 Wildwood Rd Saint Paul MN 55115-1852 | |
| (651) 439-1234 | |
| (651) 275-3325 |
| Full Name | Stillwater Medical Group Mahtomedi |
|---|---|
| Speciality | Family Medicine |
| Location | 700 Wildwood Rd, Saint Paul, Minnesota |
| Authorized Official Name and Position | Ross Bullard (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 6514391234 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stillwater Medical Group Mahtomedi 1500 Curve Crest Blvd Stillwater MN 55082-6040 Ph: (651) 439-1234 | Stillwater Medical Group Mahtomedi 700 Wildwood Rd Saint Paul MN 55115-1852 Ph: (651) 439-1234 |
| NPI Number | 1861742918 |
|---|---|
| Provider Enumeration Date | 09/17/2012 |
| Last Update Date | 07/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861742918 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 213E00000X | Podiatrist | (* (Not Available)) | Secondary |
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