Organization
PAIN SPECIALIST OF MINNESOTA
Active
Organization
PAIN SPECIALIST OF MINNESOTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK STOCK (CEO)
(651) 238-8580
Entity
Organization
Contact information
Practice address
5810 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-2830
(612) 235-6008
(612) 235-6003
Mailing address
5810 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-2830
(612) 235-6008
(612) 235-6003
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/03/2023
Last updated
01/22/2025
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