Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 27008 | MN |
NPI | 1447397849 |
---|---|
Provider Name | Donald A Pavelka |
First Address | Fridley, MN 55432-2765 |
Second Address | Fridley, MN 55432-2765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A95441 | (02) | MN |