LAKEVILLE FAMILY PRACTICE
NPI 1629244686
Clinic/Center - Primary Care in Lakeville, MN

Q: What is Mark S Mellstrom MD PA's NPI number?

The NPI number for Mark S Mellstrom MD PA is 1629244686. It was assigned to this organization in the NPPES registry on April 30, 2008. The provider is doing business as Lakeville Family Practice.

Q: What is Mark S Mellstrom MD PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Active since April 30, 2008

20157 ICENIC TRAIL, LAKEVILLE, MN 55044(952) 469-3393(952) 469-3399 Get Directions Write a Review

NPPES record last updated: April 30, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Lakeville Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKEVILLE FAMILY PRACTICE (NPI 1629244686) is a healthcare organization registered as a primary care in Lakeville, Minnesota and active in the NPI registry since April 2008. The organization lists Mark S. Mellstrom, Owner, as its authorized official.

NPPES Registry Identity

NPI1629244686

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameMARK S MELLSTROM MD PA

Location Address20157 ICENIC TRAILLakeville, MN 55044

Mailing Address20157 Icenic TrailLakeville, MN 55044 · (952) 469-3393 · Fax (952) 469-3399

Phone(952) 469-3393

Fax(952) 469-3399

Organization SubpartNo

Authorized OfficialMark S. MellstromOwner · (952) 469-3393

Enumeration DateApril 30, 2008

✔ NPI 1629244686 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

License✔ Licensed in MN · 6208286

20157 ICENIC TRAIL, Lakeville, MN 55044

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Other Names 1

Doing Business AsLakeville Family Practice

Other Identifiers 1

Medicare PIN80012011

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark S Mellstrom MD PA's NPI number?

The NPI number for Mark S Mellstrom MD PA is 1629244686. It was assigned to this organization in the NPPES registry on April 30, 2008. The provider is doing business as Lakeville Family Practice.

Where is Mark S Mellstrom MD PA located?

Mark S Mellstrom MD PA is located at 20157 Icenic Trail, Lakeville, MN 55044. The listed phone number is (952) 469-3393.

What is Mark S Mellstrom MD PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Mark S Mellstrom MD PA was last updated on April 30, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.