Individual
MARY PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
290 MAIN ST NW, ELK RIVER, MN 55330-1270
(855) 324-7843
Mailing address
290 MAIN ST NW, ELK RIVER, MN 55330-1270
(855) 324-7843
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
71839
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2019
Last updated
07/07/2022
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