Provider Demographics
NPI:1902834641
Name:DIEM, SUSAN JOANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOANNE
Last Name:DIEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET
Mailing Address - Street 2:MMC 741 UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-4426
Mailing Address - Fax:612-624-3189
Practice Address - Street 1:516 DELAWARE STREET SE, PWB THIRD FLOOR CLINIC 3A
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0995043Medicaid
MN12R06DIOtherBCBS
MNHP28827OtherHEALTHPARTNERS
MN120995OtherUCARE
MN699813500Medicaid
MN768087OtherARAZ
MN04-00788OtherMEDICA CHOICE & PRIMARY
MN1015996OtherPREFERRED ONE
MNHP28827OtherHEALTHPARTNERS
MN110004625Medicare ID - Type UnspecifiedMN MEDICARE