Ivins, Gary M

Ivins, Gary M is an individual health care provider with primary practice located at 11905 Thornhill Rd , Eden Prairie MN 55344-3276. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Ivins, Gary M can be contacted via phone (612) 669-3091.

Contact Information

Primary practice address
11905 Thornhill Rd Eden Prairie MN 55344-3276
Phone: (612) 669-3091
Fax: (952) 924-8358
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 37014 Minnesota

Profile Details

NPI number 1083610356
LBN Legal business name Ivins, Gary M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Oct 3rd, 2016 - about 9 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 1083610356 NPPES
Minnesota MEDICAID 339323200
Minnesota Other 110002645

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