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NPI Code Detail

MEDICARE: DEBORAH L ABNEY LIDAHL MD

MEDICARE: DEBORAH L ABNEY LIDAHL 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
1207P00000XEmergency Medicine Physician38946MN

General Provider Information

NPI Number : 1053386458
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH L ABNEY LIDAHL MD
Provider Business Mailing Address
First Line : 800 E 28TH ST # MR 11112
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3723
Country : US
Telephone Number : 612-863-6590
Fax Number : 612-863-5247
Provider Business Practice Location Address
First Line : 1575 BEAM AVE
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-1126
Country : US
Telephone Number : 651-232-7348
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 12/15/2021

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