Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark S Mellstrom MD PA

Organization Primary Care Clinic/Center · NPI 1629244686

Mark S Mellstrom MD PA is a Primary Care Clinic/Center in Lakeville, Minnesota. Licensed in Minnesota. Registered with an NPI since 2008.

Licensed in
MN
In the registry since
2008
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

20157 Icenic Trl
Lakeville, MN 55044
Phone: (952) 469-3393
Fax: (952) 469-3399
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X · Licence 6208286 (MN)

Record details

NPI number1629244686
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Mellstrom — Owner · (952) 469-3393
Other names Lakeville Family Practice
NPI enumeratedApril 30, 2008
Last updated in NPPESApril 30, 2008
Mailing address20157 Icenic Trail, Lakeville, MN 55044

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