Provider Demographics
NPI:1932178431
Name:EWEN, MARVEN G (MD)
Entity type:Individual
Prefix:DR
First Name:MARVEN
Middle Name:G
Last Name:EWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:PO BOX 1309 MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-937-7250
Mailing Address - Fax:
Practice Address - Street 1:15290 PENNOCK LN
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7163
Practice Address - Country:US
Practice Address - Phone:952-431-8500
Practice Address - Fax:952-431-8598
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37117207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN892219500Medicaid
MNHP13252OtherHEALTHPARTNERS
MN41686EEWOtherBLUE CROSS
MN080170657OtherRAILROAD MEDICARE
MN080170657OtherRAILROAD MEDICARE
MN41686EEWOtherBLUE CROSS
MN984811001577OtherPREFERRED ONE
MN080170657Medicare ID - Type Unspecified