Organization
IVANHOE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD DEAN MULDER M.D. (OWNER)
(507) 694-1232
Entity
Organization
Contact information
Practice address
121 W SAXON ST, IVANHOE, MN 56142-9504
(507) 694-1232
(507) 694-1171
Mailing address
121 W SAXON ST, IVANHOE, MN 56142-9504
(507) 694-1232
(507) 694-1171
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
18873
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158210100
—
MN
01
—
46119IV
BLUE CROSS BLUE SHIELD
MN
Enumeration date
04/16/2007
Last updated
08/01/2008
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