Individual
DR. MARVEN G EWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15290 PENNOCK LN, APPLE VALLEY, MN 55124-7163
(952) 431-8500
(952) 431-8598
Mailing address
8170 33RD AVE S, PO BOX 1309 MAIL STOP 21110Q, MINNEAPOLIS, MN 55425-4516
(952) 937-7250
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
37117
MN
207Q00000X
Family Medicine Physician
Primary
37117
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080170657
RAILROAD MEDICARE
MN
01
—
41686EEW
BLUE CROSS
MN
05
—
892219500
—
MN
01
—
HP13252
HEALTHPARTNERS
MN
Enumeration date
03/16/2006
Last updated
03/02/2016
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