IndividualActive
Shane Gustafson, DO
NPI 1922017623 · Sports Medicine (Family Medicine) Physician · Bloomington, MN
Provider details
- NPI number
- 1922017623
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- License
- 34-008344 (OH)
Mailing address
8170 33rd Ave S # Ms 21110q
Bloomington, MN 55425-4516
Registry dates
- Enumerated
- 2006-08-05
- Last updated
- 2021-06-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.