Edstrom, Mark Edwin
Edstrom, Mark Edwin is an individual health care provider with primary practice located at 1400 Bellinger St , Eau Claire WI 54703-5222. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Edstrom, Mark Edwin can be contacted via phone (715) 838-5222.Contact Information
Primary practice address
1400 Bellinger St
Eau Claire WI 54703-5222
Phone: (715) 838-5222
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 25244 | Wisconsin |
Profile Details
| NPI number | 1518937382 |
|---|---|
| LBN Legal business name | Edstrom, Mark Edwin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 25th, 2006 |
| Last updated | Apr 7th, 2009 - about 15 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 | 1518937382 | NPPES |
| Wisconsin | MEDICAID | 30517300 |
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