Provider Demographics
NPI:1669490439
Name:DIEKMANN, PAUL R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:DIEKMANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:8290 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1847
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-10
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Provider Licenses
StateLicense IDTaxonomies
MN30329207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
969990266006OtherPREFERREDONE
73B81DIOtherBLUE CROSS BLUE SHIELD
HP13162OtherHEALTHPARTNERS
901551OtherMEDICA
HP13162OtherHEALTHPARTNERS