Provider Demographics
NPI:1740403278
Name:MCALISTER, MARK D (ATP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:MCALISTER
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1002 MAINSTREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9415
Mailing Address - Country:US
Mailing Address - Phone:952-935-1515
Mailing Address - Fax:952-935-3050
Practice Address - Street 1:1002 MAINSTREET
Practice Address - Street 2:SUITE 100
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-9415
Practice Address - Country:US
Practice Address - Phone:952-935-1515
Practice Address - Fax:952-935-3050
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2227423332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN514130300Medicaid
MN83M68TROtherBCBS
MN5326960001Medicare ID - Type UnspecifiedMEDICARE