Individual provider · NPI-1

Dr. Gary M Ivins, MD

Internal Medicine · Eden Prairie, MN

NPI number1083610356
StatusActive
Last updated in NPPESOct 3, 2016

Details

NPI
1083610356
Entity type
Individual (NPI-1)
Name
Dr. Gary M Ivins
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 22, 2005
Last updated
Oct 3, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine37014MNYes

Practice location

11905 Thornhill Rd
Eden Prairie, MN 55344-3276

Phone 612-669-3091 · Fax 952-924-8358

Mailing address

11905 Thornhill Rd
Eden Prairie, MN 55344-3276

Phone 612-669-3091 · Fax 952-924-8358

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