DR. MARK D. GUSTAFSON (NPI# 1467439000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467439000 |
| Entity Type | Individual |
| Full Name | DR. MARK D. GUSTAFSON |
| Credential | MD |
| Practice Address |
115 10th Ave Ne Deer River MN 56636-8795 |
| Mailing Address |
1702 University Dr S Fargo ND 58103-4940 |
| Practice Telephone | 2182468275 |
| Mailing Telephone | 7013644222 |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2017-12-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 34203 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 430703800 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1601 Golf Course Rd, Grand Rapids, MN 557448648 | 2183265000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306919931 | Mark Charles Gustafson | Chiropractor | 3916 W 113th St, Bloomington, MN 55437-3503 | 2006-11-15 |
| 1114033214 | Mark Edward Gustafson | Dentist | 3431 Commerce Parkway, Suite A, Wooster, OH 44691 | 2006-08-22 |
| 1346633492 | Mark Gustafson | Pharmacist | 494 Butternut Dr, Holland, MI 49424-1556 | 2015-03-13 |
| 1851667000 | Mark Leroy Gustafson | Emergency Medicine | 3110 Maccorkle Ave Se, Charleston, WV 25304-1210 | 2012-03-31 |
| 1134108756 | Mark Gustafson | Obstetrics & Gynecology | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2006-01-12 |
| Street Address |
115 10TH AVE NE |
| City | DEER RIVER |
| State | MN |
| Zip Code | 56636-8795 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851991566 | Susan M Jewett | Physical Therapist | 115 10th Ave Ne, Deer River, MN 56636-8795 | 2020-10-30 |
| 1912505611 | Kimberly Ann Deihl | Dietitian, Registered | 115 10th Ave Ne, Deer River, MN 56636-8795 | 2020-10-14 |
| 1326512112 | Deer River Healthcare Center Inc | Family Medicine | 115 10th Ave Ne, Deer River, MN 56636-8795 | 2019-01-15 |
| 1295266898 | Deer River Healthcare Center, Inc | Ambulance | 115 10th Ave Ne, Deer River, MN 56636-8795 | 2017-03-24 |
| 1306394101 | Deer River Healthcare Center Inc | Clinic/Center | 115 10th Ave Ne, Deer River, MN 56636-8795 | 2016-09-21 |
| 1093136343 | Craig Stevens | Nurse Anesthetist, Certified Registered | 115 10th Ave Ne, Deer River, MN 56636-8975 | 2014-01-03 |
| 1669710257 | Sadie Lynn Norstrem | Speech-Language Pathologist | 115 10th Ave Ne, Essentia Health Deer River, Deer River, MN 56636-8795 | 2013-01-17 |
| 1770848772 | Daniel George Holmbeck | Physical Therapist | 115 10th Ave Ne, Deer River Healthcare Center, Deer River, MN 56636-8795 | 2012-07-06 |
| 1710242821 | Jeffrey Thomas Sheetz | Physical Therapist | 115 10th Ave Ne, Essentia Health Deer River, Deer River, MN 56636-8795 | 2012-07-05 |
| 1285999383 | Thomas Dosen-windorski | Occupational Therapist | 115 10th Ave Ne, Deer River Healthcare Center, Deer River, MN 56636-8795 | 2012-07-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417464157 | Deer River Dental Clinic | Dentist | 111 Main Street E, Deer River, MN 56636 | 2018-01-03 |
| 1992251235 | Ashley Ann Seedorf | Counselor | 313 Main Avenue, Deer River, MN 56636 | 2016-08-28 |
| 1376969675 | Thomas Kleinkauf | Family Medicine | 33688 East Point Rd, Deer River, MN 56636 | 2014-03-11 |
| 1073527651 | Brielle A Loe | Family Medicine | 300 West Conan St., Duluth Clinic-ely, Ely, MN 56636 | 2006-07-28 |
| 1619949328 | Jeffrey Lee Carter | Dentist | 111 Main Street, Deer River, MN 56636 | 2006-02-06 |
| 1811425895 | Leah Hildebrandt | Dentist | 111 Main St, Po Box 40, Deer River, MN 56636 | 2017-06-02 |
| 1689739435 | Independent School District No 317 | Local Education Agency (LEA) | 101 1st Ave Ne, Deer River, MN 56636-0307 | 2006-12-22 |
| 1144794793 | Michaela Ashlyn Fairbanks | Specialist/Technologist | 44711 County Road 18, Deer River, MN 56636-2148 | 2019-01-16 |
| 1407153158 | Judy Louise Lemieux | Chiropractor | 37958 Amen Lake Rd, Deer River, MN 56636-3064 | 2011-02-15 |
| 1043554702 | Rodney C Horgen | Chiropractor | 37958 Amen Lake Rd, Deer River, MN 56636-3064 | 2012-11-19 |
| Find all providers in zip 56636 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376969675 | Thomas Kleinkauf | Family Medicine | 33688 East Point Rd, Deer River, MN 56636 | 2014-03-11 |
| 1326512112 | Deer River Healthcare Center Inc | Family Medicine | 115 10th Ave Ne, Deer River, MN 56636-8795 | 2019-01-15 |
| 1922233261 | Jared Evan Lund | Family Medicine | 115 10th Ave Ne Ste A, Eh Deer River Clinic, Deer River, MN 56636-8795 | 2009-05-15 |
| 1134295538 | Thomas Edward Howard | Family Medicine | 1025 10th Ave Ne, Deer River, MN 56636-8703 | 2006-11-28 |
| 1861568024 | Mary Margaret Braaten | Family Medicine | 1025 10th Ave Ne, Deer River, MN 56636-8703 | 2006-11-28 |
| 1255413522 | Thomas E Osborne | Family Medicine | 115 10th Ave Ne, Essentia Health Deer River, Deer River, MN 56636-8795 | 2006-10-19 |
| 1417989351 | David Charles Goodall | Family Medicine | 1025 10th Ave Ne, Deer River, MN 56636-8703 | 2006-07-07 |
| 1609805456 | Byron David Kion Hoffman | Family Medicine | 1025 10th Ave Ne, Deer River, MN 56636-8703 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295349280 | Anna Dalrymple | Family Medicine | 3832 Mcknight Rd N, White Bear Lake, MN 55110-4874 | 2020-09-07 |
| 1760005771 | Revive Pain Centers Pa | Family Medicine | 14525 Highway 7 Ste 375, Minnetonka, MN 55345-3741 | 2020-05-26 |
| 1245862697 | North Iowa Mercy Clinics | Family Medicine | 2440 Bridge Ave, Albert Lea, MN 56007-2005 | 2020-02-04 |
| 1477196715 | The Doctors Medical Clinic, P.a. | Family Medicine | 1504 Whitebear Ave, St Paul, MN 55106 | 2019-10-18 |
| 1699336511 | Ruth Archibald | Family Medicine | 6962 Cottonwood Ct Nw, Rochester, MN 55901-8835 | 2019-06-21 |
| 1295399251 | Roberta Lynn Kopel | Family Medicine | 1605 W Lincoln Ave, Olivia, MN 56277-1260 | 2019-04-25 |
| 1558834390 | Donna Mae Mullenix | Family Medicine | 2849 Cty Rd 103, Barnum, MN 55707 | 2019-01-04 |
| 1083189203 | Altru Health System | Family Medicine | 23076 347th Street Se, Erskine, MN 56535-9466 | 2018-10-04 |
| 1477039204 | Dollar Clinic Pllc | Family Medicine | 1002 1st Ave N, Moorhead, MN 56560-2003 | 2018-07-16 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| Find all providers with the same taxonomy | ||||
| City | DEER RIVER |
| Zip Code | 56636 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.