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Mark S Mellstrom Md Pa
Primary Care Clinic/Center in Lakeville, Minnesota
NPI 1629244686

Mark S Mellstrom Md Pa is a Primary Care Clinic/Center based in Lakeville, MN and is specialized in Primary Care. Mark S Mellstrom Md Pa practices in Lakeville, MN. The NPI Number for Mark S Mellstrom Md Pa is 1629244686 and holds a License No. 6208286 (Minnesota).

The current practice location address for Mark S Mellstrom Md Pa is 20157 Icenic Trail, Lakeville, MN and can be reached out via phone at 952-469-3393 and via fax at 952-469-3399.

Location: 20157 Icenic Trail, Lakeville, MN, 55044
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1629244686
Provider Name
Mark S Mellstrom Md Pa
Credential
Provider Entity Type
Organization
Address
20157 Icenic Trail, Lakeville, MN, 55044
Phone Number
952-469-3393
Fax Number
952-469-3399
Provider Enumeration Date
04/30/2008
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
20157 Icenic Trail
City
Lakeville
State
Minnesota
Zip
55044
Phone Number
952-469-3393
Fax Number
952-469-3399
person
Provider Business Mailing Address Details
Address
20157 Icenic Trail
City
Lakeville
State
Minnesota
Zip
55044
Phone Number
952-469-3393
Fax Number
952-469-3399
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
261QP2300X
License No.
6208286 (Minnesota)
Definition
Definition to come...
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