Provider Demographics
NPI:1679505093
Name:MAYLAND, JOSEPH MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:MAYLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:MICHAEL
Other - Last Name:JELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:301 BECKER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3302
Mailing Address - Country:US
Mailing Address - Phone:320-235-4543
Mailing Address - Fax:
Practice Address - Street 1:4300 MARKETPOINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5435
Practice Address - Country:US
Practice Address - Phone:952-835-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45578207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN171487C736OtherUCARE MINNESOTA
MN011640800Medicaid
HP38725OtherHEALTH PARTNERS
FM179P6MAOtherBCBS OF MINNESOTA
1842020OtherAMERICA'S PPO
1701548OtherMEDICA
NA9231034130OtherPREFERRED ONE
MN171487C736OtherUCARE MINNESOTA
MN011640800Medicaid
MN020002140Medicare ID - Type Unspecified