Individual
DR. MARK O BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
320 EAST MAIN STREET, CROSBY, MN 56441
(218) 546-7000
(218) 546-4400
Mailing address
320 EAST MAIN STREET, CROSBY, MN 56441
(218) 546-7000
(218) 546-4400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
38115
MN
207R00000X
Internal Medicine Physician
Primary
38115
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85419100
—
MN
Enumeration date
10/02/2006
Last updated
11/19/2020
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