Individual
MATTHEW WALLNER BROSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
913 E 26TH ST STE 600, MINNEAPOLIS, MN 55404-4515
(612) 775-6200
(612) 775-6222
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13679
MN
363A00000X
Physician Assistant
8469
AZ
Other
Enumeration date
04/03/2020
Last updated
10/17/2024
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