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Individual

MARY M HIMMLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1 VETERANS DR, MAILBOX 117, MINNEAPOLIS, MN 55417-2309
(612) 231-4456
Mailing address
1 VETERANS DR, SCID CENTER, MINNEAPOLIS, MN 55417
(612) 490-4395

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4801
SD
225400000X
Rehabilitation Practitioner
M9054
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000010158222
BLUE SHIELD
ID
05
806820500
ID
01
B5634
BLUE CROSS
ID
Enumeration date
08/31/2006
Last updated
07/12/2024
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