Organization
STILLWATER MEDICAL GROUP
Active
Other names
Stillwater Medical Group Mahtomedi
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROSS BULLARD (DIRECTOR OF FINANCE)
(651) 439-1234
Entity
Organization
Contact information
Practice address
700 WILDWOOD RD, SAINT PAUL, MN 55115-1852
(651) 439-1234
(651) 275-3325
Mailing address
1500 CURVE CREST BLVD, STILLWATER, MN 55082-6040
(651) 439-1234
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
213E00000X
Podiatrist
—
—
Other
Enumeration date
09/17/2012
Last updated
07/29/2013
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