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Individual

DR. SUSAN K. MAHLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
12720 BASS LAKE RD, MAPLE GROVE, MN 55369-6307
(763) 559-2861
(763) 559-1338
Mailing address
12720 BASS LAKE RD, MAPLE GROVE, MN 55369-6307
(763) 559-2861
(763) 559-1338

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
23762
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
920795300
MN
Enumeration date
03/02/2006
Last updated
09/22/2011
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