Organization
ADVANCED INTEGRATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK BOSTROM D.O. (EXECUTIVE MEDICAL DIRECTOR)
(218) 546-7333
Entity
Organization
Contact information
Practice address
5 W MAIN ST, CROSBY, MN 56441-1421
(218) 546-7333
(218) 546-7334
Mailing address
5 W MAIN ST, CROSBY, MN 56441-1421
(218) 546-7333
(218) 546-7334
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
38115
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85419100
—
MN
Enumeration date
06/14/2011
Last updated
10/04/2011
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