Provider Demographics
NPI:1336880202
Name:GAINES, CYNTHIA LOU (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOU
Last Name:GAINES
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 1:2450 RIVERSIDE AVE.
Mailing Address - Street 2:M136, 1ST FLOOR, EAST BLDG.
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-624-4477
Mailing Address - Fax:612-626-7042
Practice Address - Street 1:2450 RIVERSIDE AVE.
Practice Address - Street 2:M136, 1ST FLOOR, EAST BLDG.
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-624-4477
Practice Address - Fax:612-626-7042
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program