Individual
DANIEL LEE MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
44763
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
981447700
—
MN
Enumeration date
06/23/2006
Last updated
05/09/2011
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