Halstrom, Mark Randy

Halstrom, Mark Randy is an individual health care provider with primary practice located at 100 2Nd St S , Sartell MN 56377-1977. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Halstrom, Mark Randy can be contacted via phone (320) 251-2600.

Contact Information

Primary practice address
100 2Nd St S Sartell MN 56377-1977
Phone: (320) 251-2600
Fax: (320) 251-4763
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 42506 Minnesota

Profile Details

NPI number 1982601647
LBN Legal business name Halstrom, Mark Randy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Aug 27th, 2013 - about 12 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 1982601647 NPPES
Minnesota MEDICAID 339524300
Minnesota Other 169318P539
Minnesota Other HP30911
Minnesota Other 41D31HA
Minnesota Other MR143-104661
Minnesota Other 01-05807
Minnesota Other 031216004

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