MEDICARE: DIANE M DAHL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	24566	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396717393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M DAHL MD

Provider Business Mailing Address
First Line	:	8170 33RD AVE S
Second Line	:	MS21110Q
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	952-883-5375
Fax Number	:	651-254-0877

Provider Business Practice Location Address
First Line	:	2345 ARIEL ST N - MAIL STOP 13601A
Second Line	:	HEALTHPARTNERS REGIONS BEHAVIORAL HEALTH-MAPLEWOOD
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-2248
Country	:	US
Telephone Number	:	651-254-4793
Fax Number	:	651-254-0877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	12/14/2011

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