Provider Demographics
NPI:1063659647
Name:THE INSTITUTE FOR EXERCISE MEDICINE AND PREVENTION
Entity Type:Organization
Organization Name:THE INSTITUTE FOR EXERCISE MEDICINE AND PREVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-605-2320
Mailing Address - Street 1:2935 COUNTRY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1183
Mailing Address - Country:US
Mailing Address - Phone:651-605-2320
Mailing Address - Fax:
Practice Address - Street 1:2935 COUNTRY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-1183
Practice Address - Country:US
Practice Address - Phone:651-605-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33524208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty