Organization
GERALD D. MCELLISTREM, M. D., P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD D MCELLISTREM (PHYSICIAN)
(651) 227-7051
Entity
Organization
Contact information
Practice address
443 HASKELL ST E, WEST SAINT PAUL, MN 55118-1600
(651) 227-7051
Mailing address
443 HASKELL ST E, WEST SAINT PAUL, MN 55118-1600
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
13266
MN
Other
Enumeration date
08/17/2008
Last updated
08/17/2008
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