Individual
MR. MARK R ZELLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
18606 ERVIN ST, WHITEHALL, WI 54773-8613
(715) 538-4355
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
8874
MN
363AM0700X
Medical Physician Assistant
Primary
507
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42918400
—
WI
05
—
874650800
—
MN
Enumeration date
06/14/2005
Last updated
02/08/2023
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