Individual
MARK H PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
204 LUNDORFF DR, SANDSTONE, MN 55072-5051
(320) 245-2250
(320) 245-2555
Mailing address
204 LUNDORFF DR, SANDSTONE, MN 55072-5051
(320) 245-2250
(320) 245-2555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
48729
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-25350
MEDICA
MN
01
—
153H5PE
BCBSMN
MN
05
—
602643000
—
MN
01
—
P00440553
RR MEDICARE PTAN
—
Enumeration date
07/28/2006
Last updated
01/03/2013
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