Organization
MARK S MELLSTROM, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK STANLEY MELLSTROM M.D (PRESIDENT)
(952) 469-3393
Entity
Organization
Contact information
Practice address
20157 ICENIC TRL, LAKEVILLE, MN 55044-7708
(952) 469-3393
(952) 469-3399
Mailing address
20157 ICENIC TRL, LAKEVILLE, MN 55044-7708
(952) 469-3393
(952) 469-3399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27926
MN
Other
Enumeration date
03/19/2008
Last updated
04/23/2008
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