Domeyer, Evan L

Domeyer, Evan L is an individual health care provider with primary practice located at 3960 Coon Rapids Blvd Nw 100, Coon Rapids MN 55433-2569. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Domeyer, Evan L can be contacted via phone (763) 236-9400.

Contact Information

Primary practice address
3960 Coon Rapids Blvd Nw 100 Coon Rapids MN 55433-2569
Phone: (763) 236-9400
Fax: (763) 236-9423
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 44533 Minnesota

Profile Details

NPI number 1033178538
LBN Legal business name Domeyer, Evan L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 22nd, 2006
Last updated Nov 10th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033178538 NPPES
Minnesota MEDICAID 315794600

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