Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 59194 | MN |
NPI | 1003059510 |
---|---|
Provider Name | Trevor Mciver |
First Address | Sartell, MN 56377 |
Second Address | Sartell, MN 56377-2554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2009 |
Last Update Date | 08/06/2020 |