Individual
EILEEN S GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
333 PINE RIDGE BLVD, WAUSAU, WI 54401-4120
(715) 847-2505
Mailing address
PO BOX 1008, WAUSAU, WI 54402-1008
(715) 847-2148
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36931
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32161800
—
WI
Enumeration date
07/11/2006
Last updated
09/18/2009
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