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Organization
STILLWATER MEDICAL GROUP
Active
Organization
STILLWATER MEDICAL GROUP
Active
Other names
Stillwater Medical Group Mahtomedi
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROSS BULLARD (DIRECTOR OF FINANCE)
(651) 439-1234
Entity
Organization
Contact information
Practice address
700 WILDWOOD RD, SAINT PAUL, MN 55115-1852
(651) 439-1234
(651) 275-3325
Mailing address
1500 CURVE CREST BLVD, STILLWATER, MN 55082-6040
(651) 439-1234
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
213E00000X
Podiatrist
—
—
Other
Enumeration date
09/17/2012
Last updated
07/29/2013
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