MEDICARE: DR. MICHAEL G MESICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	033402	MN

General Provider Information

NPI Number	:	1376597310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL G MESICK M.D.

Provider Business Mailing Address
First Line	:	6363 FRANCE AVE S
Second Line	:	SUITE 525
City	:	EDINA
State	:	MN
Zip	:	55435-2129
Country	:	US
Telephone Number	:	952-926-6489
Fax Number	:

Provider Business Practice Location Address
First Line	:	6363 FRANCE AVE S
Second Line	:	SUITE 525
City	:	EDINA
State	:	MN
Zip	:	55435-2129
Country	:	US
Telephone Number	:	952-926-6489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/09/2010

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