Individual
STEPHEN RICHARD PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1542 GOLF COURSE RD STE 204, GRAND RAPIDS, MN 55744-3555
(218) 999-7000
(218) 999-7099
Mailing address
1542 GOLF COURSE RD STE 204, GRAND RAPIDS, MN 55744-3555
(218) 999-7000
(218) 999-7099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25060
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302568300
—
MN
Enumeration date
07/14/2006
Last updated
05/01/2018
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