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NPI Code Detail

MEDICARE: CATHLEEN ANN IVY MD

MEDICARE: CATHLEEN ANN IVY MD
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 PhysicianME49653FL

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 : 1851394944
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHLEEN ANN IVY MD
Provider Business Mailing Address
First Line : 11995 SINGLETREE LN STE 500
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-5349
Country : US
Telephone Number : 952-595-1301
Fax Number : 612-294-4903
Provider Business Practice Location Address
First Line : 11995 SINGLETREE LN STE 500
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-5349
Country : US
Telephone Number : 952-595-1301
Fax Number : 612-294-4903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 09/18/2020

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Directions to “ CATHLEEN ANN IVY MD” Practice Location

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