Healthcare Provider Details

I. General information

NPI: 1205098399
Provider Name (Legal Business Name): COLLEEN LEE RIVARD HUNT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLLEEN RIVARD MD

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MAYO MAIL CODE 395
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

420 DELAWARE ST SE MAYO MAIL CODE 395
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-3111
  • Fax:
Mailing address:
  • Phone: 612-626-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number55439
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: