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Individual

MATTHEW LESTER MIELKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3456
(651) 254-9673
Mailing address
PO BOX 1309, MS 21110Q, MINNEAPOLIS, MN 55440-1309
(651) 254-3456
(651) 254-9673

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
62093
MN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/17/2013
Last updated
07/21/2022
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