| Doctor Name: | MICHAEL JOEL MASTOUS |
| NPI Number: | 1073865465 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 1821 |
| Business Practice Address: | 8540 Quaday Ave Ne Otsego, MN - 553306522 |
| Business Phone Number: | 7634410298 |
| Business Fax Number: | 7634410591 |
| Mailing Address: | 4200 Dahlberg Dr, Suite 300 GOLDEN VALLEY |
| State: | MN |
| Postal Code: | 554224840 |
| Phone Number: | 9525125600 |
| Fax Number: | 9525125651 |
| NPI Enumeration Date: | 10/09/2012 |
| NPI Last Update Date: | 10/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1821 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |