Tracie M Mallberg MD PC
Clinic/Center, Primary Care in West Fargo, ND. Organization (NPI-2).
NPI number1023282969
StatusActive
Last updated in NPPESAug 1, 2008
Details
- NPI
- 1023282969
- Entity type
- Organization (NPI-2)
- Legal business name
- Tracie M Mallberg MD PC
- Organization subpart
- No
- Enumeration date
- Apr 22, 2008
- Last updated
- Aug 1, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | 9395 | ND | Yes |
Other names
- Lilycare Clinic (Doing Business As)
Practice location
550 13th Ave EWest Fargo, ND 58078-3360
Phone 701-356-5459 · Fax 701-356-3764
Mailing address
550 13th Ave EWest Fargo, ND 58078-3360
Phone 701-356-5459 · Fax 701-356-3764
Authorized official
Tracie M Mallberg
President
7013565459
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