Individual
DR. GARY M IVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11905 THORNHILL RD, EDEN PRAIRIE, MN 55344-3276
(612) 669-3091
(952) 924-8358
Mailing address
11905 THORNHILL RD, EDEN PRAIRIE, MN 55344-3276
(612) 669-3091
(952) 924-8358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37014
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110002645
MEDICARE
MN
05
—
339323200
—
MN
Enumeration date
06/22/2005
Last updated
10/03/2016
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