Provider Demographics
NPI:1346218823
Name:DIEN, PHILIP Y (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:Y
Last Name:DIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:675 E NICOLLET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6749
Practice Address - Country:US
Practice Address - Phone:952-892-7190
Practice Address - Fax:952-892-7956
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32130207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110999OtherUCARE MN
MNHP13164OtherHEALTHPARTNERS
MN3600788OtherMEDICA
WI31682200Medicaid
MN8T408DIOtherBLUE CROSS BLUE SHIELD MN
MN0104004OtherPREFERRED ONE
MN523590100Medicaid
MN23252OtherAMERICA'S PPO
MN523590100Medicaid
MN900000630Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN900000088Medicare ID - Type UnspecifiedMN MEDICARE