Individual
MICHAEL L BRISTOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
610 30TH AVE W, ALEXANDRIA CLINIC, ALEXANDRIA, MN 56308
(320) 763-5123
(320) 763-7883
Mailing address
610 30TH AVE W, ALEXANDRIA CLINIC, ALEXANDRIA, MN 56308
(320) 763-5123
(320) 763-7883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32086
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080050444
RR MEDICARE
MN
05
—
401783800
—
MN
Enumeration date
01/19/2006
Last updated
03/30/2018
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