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Individual

MALLARY WEST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
6517 DREW AVE S, EDINA, MN 55435-2103
(952) 920-9191
Mailing address
6517 DREW AVE S, EDINA, MN 55435-2103

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
71840
MN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/09/2019
Last updated
01/24/2023
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