Mark S Mellstrom, Md, PA

NPI #1639340409 in Lakeville, Minnesota

Provider Information

NPI Number: 1639340409
Entity Type: Organization
Organization Name: Mark S Mellstrom, Md, PA
Primary Specialty: Family Medicine
Enumeration Date: Mar 19, 2008
Last Updated: Apr 23, 2008

Practice Location

Address: 20157 ICENIC TRL
City: Lakeville
State: Minnesota
ZIP Code: 55044-7708
Phone: (952) 469-3393

Authorized Official

Name: MR. MARK STANLEY MELLSTROM, M.D
Title: PRESIDENT
Phone: (952) 469-3393

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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