Individual
MS. TRACIE MARIE MALLBERG- SYLVESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1701 38TH ST S STE 101, FARGO, ND 58103-4499
(701) 356-1500
(701) 356-1596
Mailing address
1701 38TH ST S STE 101, FARGO, ND 58103-4499
(701) 356-1500
(701) 356-1596
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
46245
MN
207Q00000X
Family Medicine Physician
Primary
9395
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156629600
—
MN
01
—
490K2MA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
08/07/2006
Last updated
10/28/2021
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