Individual
IAN MARK MCQUISTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-1166
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-1166
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
53952
MN
208M00000X
Hospitalist Physician
3938
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295934255
—
IA
Enumeration date
07/11/2007
Last updated
12/07/2023
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