Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 32695 | MN |
NPI | 1003883703 |
---|---|
Provider Name | Robert E Mcklveen |
First Address | Minneapolis, MN 55404-4522 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C04335 | (02) |