Ivory, Michael Eric

Ivory, Michael Eric is an individual health care provider with primary practice located at 516 E. Nizhoni Blvd. , Gallup NM 87301-1337. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Ivory, Michael Eric can be contacted via phone (505) 722-1000.

Contact Information

Primary practice address
516 E. Nizhoni Blvd. Gallup NM 87301-1337
Phone: (505) 722-1000
Fax: (505) 726-8740
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 5101007170 Michigan

Profile Details

NPI number 1952521874
LBN Legal business name Ivory, Michael Eric
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2007
Last updated Sep 27th, 2012 - about 14 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 1952521874 NPPES
Wisconsin MEDICAID 30010400
Wisconsin MEDICAID 4709700

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