Bostrom, Mark O

Bostrom, Mark O is an individual health care provider with primary practice located at 320 East Main Street , Crosby MN 56441. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Bostrom, Mark O can be contacted via phone (218) 546-7000.

Contact Information

Primary practice address
320 East Main Street Crosby MN 56441
Phone: (218) 546-7000
Fax: (218) 546-4400
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 38115 Minnesota
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 38115 Minnesota

Profile Details

NPI number 1902990419
LBN Legal business name Bostrom, Mark O
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2006
Last updated Nov 19th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902990419 NPPES
Minnesota MEDICAID 85419100

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