Healthcare Provider Details

I. General information

NPI: 1598877896
Provider Name (Legal Business Name): MARY M HIMMLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/12/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR MAILBOX 117
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR SCID CENTER
MINNEAPOLIS MN
55417
US

V. Phone/Fax

Practice location:
  • Phone: 612-231-4456
  • Fax:
Mailing address:
  • Phone: 612-490-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberM9054
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4801
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: