Provider Demographics
NPI:1548273303
Name:SAMUELSSON, MELISSA K (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:SAMUELSSON
Suffix:
Gender:
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-2400
Practice Address - Country:US
Practice Address - Phone:651-495-6300
Practice Address - Fax:952-967-7616
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI563952084N0400X
NY2568302084N0400X
MN545832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology