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:
Health care specialties
Specialty | Code | License # | 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 8 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1083610356 | NPPES |
Minnesota | MEDICAID | 339323200 | |
Minnesota | Other | 110002645 |
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