Provider Demographics
NPI:1952349169
Name:REVOIR, ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:REVOIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:HOGENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:STE LL
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-5629
Mailing Address - Fax:
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:STE LL
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38650207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1011800OtherPREFERRED ONE
WI32262000OtherMEDICAID
MN38T68REOtherBCBSM
MNA009OtherTRIWEST
MN847326900Medicaid
MNHP22609OtherHEALTH PARTNERS
MN07-00154OtherMEDICA
MN115834OtherUCARE
MN160030895OtherRAILROAD MEDICARE