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NPI Code Detail

MEDICARE: WILLIAM J. GARVIS M.D.

MEDICARE: WILLIAM J. GARVIS 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
1207YX0901XOtology & Neurotology Physician39040MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11000009OTHERMNMEDICA CHOICE
21012225OTHERMNPREFERREDONE
3236167OTHERMNAMERICA'S PPO
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
51000010OTHERMNMEDICA PRIMARY
6115458OTHERMNUCARE
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
832Y69GAOTHERMNBLUE SHIELD

General Provider Information

NPI Number : 1780686584
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM J. GARVIS M.D.
Provider Business Mailing Address
First Line : 2211 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3711
Country : US
Telephone Number : 612-871-1144
Fax Number : 612-871-2012
Provider Business Practice Location Address
First Line : 2211 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3711
Country : US
Telephone Number : 612-871-1144
Fax Number : 612-871-2012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 05/22/2013

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Directions to “ WILLIAM J. GARVIS M.D.” Practice Location

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