Individual
MR. MARK RANDY HALSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 2ND ST S, SARTELL, MN 56377-1977
(320) 251-2600
(320) 251-4763
Mailing address
PO BOX 296, SARTELL, MN 56377-0296
(320) 251-2600
(320) 251-4763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42506
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-05807
MEDICA
MN
01
—
031216004
PRIME WEST
MN
01
—
169318P539
UCARE
MN
05
—
339524300
—
MN
01
—
41D31HA
BLUE CROSS BLUE SHIELD
MN
01
—
HP30911
HEALTH PARTNERS
MN
01
—
MR143-104661
PREFERRED ONE
MN
Enumeration date
07/07/2005
Last updated
08/27/2013
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