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MARK S MELLSTROM, MD, PA
NPI 1639340409
Family Medicine in Lakeville, MN

Active since March 19, 2008
20157 ICENIC TRL, LAKEVILLE, MN 55044(952) 469-3393(952) 469-3399 Get Directions Write a Review

NPPES record last updated: April 23, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mark S Mellstrom, Md, Pa NPPES

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

MARK S MELLSTROM, MD, PA (NPI 1639340409) is a healthcare organization registered as a family medicine in Lakeville, Minnesota and active in the NPI registry since March 2008. The organization lists Mark Stanley Mellstrom, President, as its authorized official.

NPPES Registry Identity

NPI1639340409
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMARK S MELLSTROM, MD, PA
Location Address20157 ICENIC TRLLakeville, MN 55044-7708
Mailing Address20157 Icenic TrlLakeville, MN 55044-7708 · (952) 469-3393 · Fax (952) 469-3399
Phone(952) 469-3393
Fax(952) 469-3399
Organization SubpartNo
Authorized OfficialMark Stanley MellstromPresident · (952) 469-3393
Enumeration DateMarch 19, 2008
Last NPPES UpdateApril 23, 2008
✔ NPI 1639340409 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MN · 27926
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
20157 ICENIC TRL, Lakeville, MN 55044
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Other Identifiers 1

Medicare UPIND48811MN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 1639340409. It was assigned to this organization in the NPPES registry on March 19, 2008.

Where is Mark S Mellstrom, MD, PA located?

Mark S Mellstrom, MD, PA is located at 20157 Icenic Trl, 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 Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Mark S Mellstrom, MD, PA was last updated on April 23, 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.