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Individual
MR. MARK RANDY HALSTROM
Active
Individual
MR. MARK RANDY HALSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42506
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-05807
MEDICA
MN
01
—
031216004
PRIME WEST
MN
01
—
169318P539
UCARE
MN
05
—
339524300
—
MN
01
—
41D31HA
BLUE CROSS BLUE SHIELD
MN
01
—
HP30911
HEALTH PARTNERS
MN
01
—
MR143-104661
PREFERRED ONE
MN
Enumeration date
07/07/2005
Last updated
08/27/2013
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