Provider Demographics
NPI:1255310967
Name:SOLBERG-DANIELS, DEIDRE JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:JEANNE
Last Name:SOLBERG-DANIELS
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 1:2330 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2950
Mailing Address - Country:US
Mailing Address - Phone:612-781-1212
Mailing Address - Fax:612-781-5251
Practice Address - Street 1:2330 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2950
Practice Address - Country:US
Practice Address - Phone:612-781-1212
Practice Address - Fax:612-781-5251
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ166688Medicaid
AZ166688Medicaid