Active NPI
Melissa C. Mark, M.D.
- Family Medicine Physician
- Minneapolis, MN
National Provider Identifier
1568437150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 40755
- Practice address
- 3033 Excelsior Blvd
#275
Minneapolis, MN 55416-4688 - Phone
- (612) 827-4751
- NPI assigned
- Feb 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 40755 | MN | Primary |
Addresses
Primary practice location
3033 Excelsior Blvd
#275
Minneapolis, MN 55416-4688
Mailing address
3033 Excelsior Blvd Ste 275
Minneapolis, MN 55416-5149
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40755 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210809600000",
"number": "1568437150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3033 EXCELSIOR BLVD STE 275",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554165149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3033 EXCELSIOR BLVD",
"address_2": "#275",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554164688",
"telephone_number": "612-827-4751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARK",
"first_name": "MELISSA",
"middle_name": "C.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-17",
"last_updated": "2008-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "40755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.