Provider Demographics
NPI:1710044185
Name:KIRVEN, EMILLIE DEDON (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILLIE
Middle Name:DEDON
Last Name:KIRVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 31ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3812
Mailing Address - Country:US
Mailing Address - Phone:612-216-2137
Mailing Address - Fax:
Practice Address - Street 1:4705 31ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3812
Practice Address - Country:US
Practice Address - Phone:612-216-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics