Individual
MICHAEL JOEL MASTOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8100 W 78TH ST STE 230, EDINA, MN 55439-2570
(952) 946-9777
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1821
MN
Other
Enumeration date
10/09/2012
Last updated
03/11/2021
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