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NPI Code Detail

MEDICARE: DR. JOHN W MCIVOR M.D.

MEDICARE: DR. JOHN W MCIVOR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician093421NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184607426
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN W MCIVOR M.D.
Provider Business Mailing Address
First Line : 11995 SINGLETREE LN
Second Line : STE 500
City : EDEN PRAIRIE
State : MN
Zip : 55344-5347
Country : US
Telephone Number : 952-595-1100
Fax Number : 952-942-3361
Provider Business Practice Location Address
First Line : 301 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8408
Country : US
Telephone Number : 952-595-1100
Fax Number : 952-942-3361
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 01/19/2011

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Directions to “ DR. JOHN W MCIVOR M.D.” Practice Location

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