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

Alicia Gustafson, DO

Individual provider Family Medicine Physician · NPI 1417210790

Alicia Gustafson, DO is a Sports Medicine in Bloomington, Minnesota. Graduated from Edward via Col of Osteo Medicine-Virginia Campus in 2012, 14 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota and Texas.

Years since qualifying
14
Trained at
Edward via Col of Osteo Medicine-Virginia Campus
Licensed in
MN, TX
In the registry since
2012
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

8100 Northland Dr
Bloomington, MN 55431-4800
Phone: (952) 831-8742
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Additional practice locations (1)

  • 1976 Texan Dr., Suite 106, Justin, TX 76247 — (682) 212-9020

Specialties & licences

Sports Medicine (Internal Medicine) Physician (primary) Taxonomy 207RS0010X · Licence 75542 (MN)
Family Medicine Physician Taxonomy 207Q00000X · Licence S9140 (TX)
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X · Licence S9140 (TX)

Record details

NPI number1417210790
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorNo
NPI enumeratedJune 21, 2012
Last updated in NPPESMay 10, 2024
Certification dateMay 10, 2024
Mailing address8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtySPORTS MEDICINE
Medical schoolEDWARD VIA COL OF OSTEO MEDICINE-VIRGINIA CAMPUS
Graduated 2012 (14 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Bloomington