Provider Demographics
NPI:1093332389
Name:DONOVITCH, MYRIAM JACYNTHE (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:JACYNTHE
Last Name:DONOVITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYRIAM
Other - Middle Name:JACYNTHE
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 VIKINGS PKWY UNIT 120
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1948
Mailing Address - Country:US
Mailing Address - Phone:773-658-4545
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-626-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73668390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program