Organization · Type 2 NPI
Mark S Mellstrom MD PA
Primary Care Clinic/Center · Lakeville, MN
NPI number
1629244686
Active
Practice location
20157 Icenic Trail
Lakeville, MN 55044
Fax (952) 469-3399
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center Primary | 261QP2300X | 6208286 (MN) |
Primary Care Clinic/Center: Definition to come...
Other primary care clinic/center providers in Lakeville
About NPI 1629244686
Mark S Mellstrom MD PA's National Provider Identifier is 1629244686, issued on Apr 30, 2008. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Lakeville, MN. The record was last updated on Apr 30, 2008.