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:
Health care specialties
| Specialty | Code | License # | 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 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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