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Organization
MARK S MELLSTROM MD PA
Active
Organization
MARK S MELLSTROM MD PA
Active
Other names
Lakeville Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S. MELLSTROM M.D. (OWNER)
(952) 469-3393
Entity
Organization
Contact information
Practice address
20157 ICENIC TRAIL, LAKEVILLE, MN 55044
(952) 469-3393
(952) 469-3399
Mailing address
20157 ICENIC TRAIL, LAKEVILLE, MN 55044
(952) 469-3393
(952) 469-3399
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
6208286
MN
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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