Organization
TRACIE M MALLBERG MD PC
Active
Other names
LilyCare Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACIE M MALLBERG M.D. (PRESIDENT)
(701) 356-5459
Entity
Organization
Contact information
Practice address
550 13TH AVE E, WEST FARGO, ND 58078-3360
(701) 356-5459
(701) 356-3764
Mailing address
550 13TH AVE E, WEST FARGO, ND 58078-3360
(701) 356-5459
(701) 356-3764
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
9395
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14788
—
ND
Enumeration date
04/22/2008
Last updated
08/01/2008
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