Provider Demographics
NPI:1962497156
Name:RIEDEL, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:RIEDEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-567-6092
Mailing Address - Fax:952-567-6176
Practice Address - Street 1:9801 DUPONT AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-884-2656
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2013-03-25
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Provider Licenses
StateLicense IDTaxonomies
MN36405207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34376400Medicaid
MN629063900Medicaid
MN629063900Medicaid
MN180001104Medicare PIN