Provider Demographics
NPI:1851409395
Name:TANABE, DIANE SIONE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:SIONE
Last Name:TANABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 18128
Mailing Address - Street 2:LUFKIN EYE CLINIC, PA
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-0128
Mailing Address - Country:US
Mailing Address - Phone:651-292-8205
Mailing Address - Fax:651-292-1801
Practice Address - Street 1:280 SMITH AVE N STE 400
Practice Address - Street 2:LUFKIN EYE CLINIC, PA
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2473
Practice Address - Country:US
Practice Address - Phone:651-292-8200
Practice Address - Fax:651-292-1801
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2017-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN21440207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN841890000Medicaid
MN180010745OtherPALMETTO GBA RAILROAD MED
MN28943TAOtherBCBS OF MINNESOTA
MN28943TAOtherBCBS OF MINNESOTA
MN180000152Medicare ID - Type Unspecified