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

Mark S Mellstrom, MD, PA

Organization Family Medicine Physician · NPI 1639340409

Mark S Mellstrom, MD, PA is a Family Medicine Physician 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 55044-7708
Phone: (952) 469-3393
Fax: (952) 469-3399
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 27926 (MN)

Record details

NPI number1639340409
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Mellstrom — President · (952) 469-3393
NPI enumeratedMarch 19, 2008
Last updated in NPPESApril 23, 2008
Mailing address20157 Icenic Trl, Lakeville, MN 55044-7708

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