Divine, Alan

Divine, Alan is an individual health care provider with primary practice located at 825 S 8Th St Parkside Professional Bldg., Ste 600, Minneapolis MN 55404-1208. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Divine, Alan can be contacted via phone (612) 339-7171.

Contact Information

Primary practice address
825 S 8Th St Parkside Professional Bldg., Ste 600 Minneapolis MN 55404-1208
Phone: (612) 339-7171
Fax: (612) 339-2885
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 26378 Minnesota

Profile Details

NPI number 1104825280
LBN Legal business name Divine, Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2005
Last updated Nov 10th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104825280 NPPES
Minnesota Other 0401146 MEDICA
Minnesota MEDICAID 876265100 MEDICA
Minnesota Other HP19647 MEDICA

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