Provider Demographics
NPI:1972686442
Name:MADLON-KAY, DIANE J (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:J
Last Name:MADLON-KAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 EAST 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1453
Mailing Address - Country:US
Mailing Address - Phone:612-333-0770
Mailing Address - Fax:612-333-1986
Practice Address - Street 1:2020 EAST 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:612-333-1986
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01-21285OtherMEDICA CHOICE
2380613OtherARAZ
HP10946OtherHEALTH PARTNERS
MN506K0MAOtherBLUECROSS BLUESHIELD
A054OtherTRIWEST/TRICARE
1018848OtherPREFERRED ONE
WI31360100Medicaid
01-21285OtherMEDICA PRIMARY
IA0596247Medicaid
105929OtherUCARE
MN080014430Medicare ID - Type Unspecified
WI31360100Medicaid
IA0596247Medicaid