Provider Demographics
NPI:1396717393
Name:DAHL, DIANE M (MD)
Entity type:Individual
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First Name:DIANE
Middle Name:M
Last Name:DAHL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-254-0877
Practice Address - Street 1:2345 ARIEL ST N - MAIL STOP 13601A
Practice Address - Street 2:HEALTHPARTNERS REGIONS BEHAVIORAL HEALTH-MAPLEWOOD
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2248
Practice Address - Country:US
Practice Address - Phone:651-254-4793
Practice Address - Fax:651-254-0877
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-12-14
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Provider Licenses
StateLicense IDTaxonomies
MN245662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN202707100Medicaid
D81582Medicare UPIN
MN202707100Medicaid