Individual
MARK DAVID BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
535 HOSPITAL RD, NEW RICHMOND, WI 54017-1449
(715) 243-2600
Mailing address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
64340
MN
207Q00000X
Family Medicine Physician
Primary
73969
WI
Other
Enumeration date
06/06/2017
Last updated
07/21/2022
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