Healthcare Provider Details

I. General information

NPI: 1568343663
Provider Name (Legal Business Name): IVAN SABIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FEDERAL DR STE 1640 ATTN: IVAN SABIN
FORT SNELLING MN
55111-2200
US

IV. Provider business mailing address

1 FEDERAL DR STE 1640 ATTN: IVAN SABIN
FORT SNELLING MN
55111-2200
US

V. Phone/Fax

Practice location:
  • Phone: 612-258-0132
  • Fax:
Mailing address:
  • Phone: 612-258-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM5148838
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: